Srdjan Ilic-Siljak, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2008011096 Issued in MO

Practice address

2915 S Brentwood Blvd
Brentwood, MO 63144-2713

Phone

(314) 962-6622

Fax

(314) 961-2288

NPI assigned

May 3, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prestige Dental Care, LLC

  • General Practice Dentistry
  • Saint Louis, MO
  • NPI 1174618045
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1659339893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2915 S BRENTWOOD BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631442713",
            "telephone_number": "314-962-6622",
            "fax_number": "314-961-2288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2915 S BRENTWOOD BLVD",
            "city": "BRENTWOOD",
            "state": "MO",
            "postal_code": "631442713",
            "telephone_number": "314-962-6622",
            "fax_number": "314-961-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILIC-SILJAK",
        "first_name": "SRDJAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2008011096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Anthony Hough, DDS
• Tiffaney Howard, RN
• Jill A Hruskocy, LPN
• Nicholas Anthony Iafe, MD
• Dante Joseph Iannazzo, D.C.
• Mary Randall Ivy, MSDE
• Nicole R Jackson, DPT
• Susan Johnson, RSAP
• Isaac Julius, DMD
• Megan Kartheiser, M.ED, LPC, RPT

• General Practice Dentistry in Brentwood, MO
• Providers in Brentwood, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.