Provider Demographics
NPI:1386095933
Name:MICHAEL A. ESPOSITO DDS, P.C.
Entity type:Organization
Organization Name:MICHAEL A. ESPOSITO DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-544-9773
Mailing Address - Street 1:5646 SAINT CHARLES RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BERKELEY
Mailing Address - State:IL
Mailing Address - Zip Code:60163-1148
Mailing Address - Country:US
Mailing Address - Phone:708-544-9773
Mailing Address - Fax:
Practice Address - Street 1:5646 SAINT CHARLES RD
Practice Address - Street 2:SUITE C
Practice Address - City:BERKELEY
Practice Address - State:IL
Practice Address - Zip Code:60163-1148
Practice Address - Country:US
Practice Address - Phone:708-544-9773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0191001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019-019100OtherSTATE DENTAL LICENSE