Active NPI
Leesa Ann Sasic-Mitsos, DDS PC
- Dentist
- New Lenox, IL
National Provider Identifier
1144478140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019018604
- Practice address
- 1804 E Lincoln Hwy
New Lenox, IL 60451 - Phone
- (815) 462-4838
- Fax
- (815) 462-7748
- NPI assigned
- Sep 3, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019018604 | IL | Primary |
Addresses
Primary practice location
1804 E Lincoln Hwy
New Lenox, IL 60451
Mailing address
1804 E Lincoln Hwy
New Lenox, IL 60451
Phone (815) 462-4838
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019018604 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220400000000",
"number": "1144478140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1804 E LINCOLN HWY",
"city": "NEW LENOX",
"state": "IL",
"postal_code": "60451",
"telephone_number": "815-462-4838",
"fax_number": "815-462-7748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1804 E LINCOLN HWY",
"city": "NEW LENOX",
"state": "IL",
"postal_code": "60451",
"telephone_number": "815-462-4838",
"fax_number": "815-462-7748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SASIC-MITSOS",
"first_name": "LEESA",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "DDS PC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-03",
"last_updated": "2008-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019018604",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Lenox, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.