Provider Demographics
NPI:1912588930
Name:JAMES MITSOS DMD PLLC
Entity Type:Organization
Organization Name:JAMES MITSOS DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MITSOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:708-557-5584
Mailing Address - Street 1:10759 WINTERSET DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-1106
Mailing Address - Country:US
Mailing Address - Phone:708-580-0404
Mailing Address - Fax:708-966-0154
Practice Address - Street 1:10759 WINTERSET DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-1106
Practice Address - Country:US
Practice Address - Phone:708-580-0404
Practice Address - Fax:708-966-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty