Provider Demographics
NPI:1629499025
Name:VITO P. LASUSA, D.D.S., LLC
Entity Type:Organization
Organization Name:VITO P. LASUSA, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VITO
Authorized Official - Middle Name:P
Authorized Official - Last Name:LASUSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-236-2968
Mailing Address - Street 1:25 E WASHINGTON ST
Mailing Address - Street 2:SUITE 2025
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1708
Mailing Address - Country:US
Mailing Address - Phone:312-236-2968
Mailing Address - Fax:312-443-1156
Practice Address - Street 1:25 E WASHINGTON ST
Practice Address - Street 2:SUITE 2025
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1708
Practice Address - Country:US
Practice Address - Phone:312-236-2968
Practice Address - Fax:312-443-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-024973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty