# JAMES MITSOS DMD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southwest Pediatric Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912588930
- **Authorized official:** CASSANDRA WIETH (DIRECTOR OF PAYOR RELATIONS)
- **Authorized official phone:** (623) 267-8121

## Contact information

- **Practice address:** 10759 WINTERSET DR, ORLAND PARK, IL 60467-1106
- **Practice address phone:** (708) 580-0404
- **Practice address fax:** (708) 966-0154
- **Mailing address:** 10759 WINTERSET DR, ORLAND PARK, IL 60467-1106
- **Mailing address phone:** (708) 580-0404
- **Mailing address fax:** (708) 966-0154

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/20/2021
- **Last updated:** 09/18/2026