Provider Demographics
NPI:1093594905
Name:ANGELA LEBESSIS DDS PLLC
Entity Type:Organization
Organization Name:ANGELA LEBESSIS DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBESSIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-579-1522
Mailing Address - Street 1:1400 W 47TH ST STE 8
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6148
Mailing Address - Country:US
Mailing Address - Phone:708-579-1522
Mailing Address - Fax:
Practice Address - Street 1:1400 W 47TH ST STE 8
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6148
Practice Address - Country:US
Practice Address - Phone:708-579-1522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental