John Michael Sisto, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

019016656 Issued in IL

Practice address

111 S. Washington
Ste 101
Park Ridge, IL 60068

Phone

(847) 696-4848

Fax

(847) 696-1609

NPI assigned

Apr 17, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242864000000",
    "number": "1336365642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 S NORTHWEST HWY",
            "address_2": "STE 118",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684216",
            "telephone_number": "847-696-4848",
            "fax_number": "847-696-1609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S. WASHINGTON",
            "address_2": "STE 101",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "60068",
            "telephone_number": "847-696-4848",
            "fax_number": "847-696-1609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISTO",
        "first_name": "JOHN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2009-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019016656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manisha Singh, MD, MPH
• Prabhkirin Mohini Singh, PSYD
• Sevgi Sipahi, M.D.
• Ronald L. Sirota, M.D.
• Amanda Sirotzki
• Shoeb Jamaludin Sitafalwalla, M.D.
• Betty Siuba, M.S.
• Nikhita Sivagnanakumar, MD
• SJ.S. Medical Testing Services
• SJP Comprehensive Medicine Inc

• Oral and Maxillofacial Surgery (Dentist) in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.