Provider Demographics
NPI:1558978841
Name:WILLIAM MITSOS DDS
Entity Type:Organization
Organization Name:WILLIAM MITSOS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MITSOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-932-0022
Mailing Address - Street 1:1291 S. 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901
Mailing Address - Country:US
Mailing Address - Phone:815-932-0022
Mailing Address - Fax:815-932-1202
Practice Address - Street 1:1291 S. 7TH AVE
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901
Practice Address - Country:US
Practice Address - Phone:815-932-0022
Practice Address - Fax:815-932-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty