MEDICARE: A 2 Z DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386816114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A 2 Z DENTAL

Provider Business Mailing Address
First Line	:	1605 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1209
Country	:	US
Telephone Number	:	312-212-0000
Fax Number	:	312-212-0001

Provider Business Practice Location Address
First Line	:	1605 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1209
Country	:	US
Telephone Number	:	312-212-0000
Fax Number	:	312-212-0001

Authorized Official
Title or Position	:	DOCTOR
Name	:	SASA STOJANOVIC
Credential	:	DDS
Telephone Number	:	312-212-0000

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	04/01/2008

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Directions to “A 2 Z DENTAL ” Practice Location

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