=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942502463
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VLADANA BABCIC TAL DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2010
-----------------------------------------------------
Last Update Date | 02/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 S PAULINA ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60612-7210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-215-5550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 PARK AVE
-----------------------------------------------------
City | GLENCOE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60022-1334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-215-5550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 019028394
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------