Provider Demographics
NPI:1205034618
Name:KAVETSIS, LANA (DDS)
Entity type:Individual
Prefix:DR
First Name:LANA
Middle Name:
Last Name:KAVETSIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3909
Mailing Address - Country:US
Mailing Address - Phone:773-904-7079
Mailing Address - Fax:773-698-7832
Practice Address - Street 1:2015 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3909
Practice Address - Country:US
Practice Address - Phone:773-904-7079
Practice Address - Fax:773-698-7832
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190273801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice