Provider Demographics
NPI:1568987766
Name:MITSOS, JANNA LEE (DMD)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:LEE
Last Name:MITSOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E 104TH AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4402
Mailing Address - Country:US
Mailing Address - Phone:303-452-4142
Mailing Address - Fax:
Practice Address - Street 1:2200 E 104TH AVE STE 112
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4402
Practice Address - Country:US
Practice Address - Phone:303-462-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031242122300000X
CO002042441223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist