Healthcare Provider Details

I. General information

NPI: 1932020492
Provider Name (Legal Business Name): ESTHER PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2822 N ASHLAND AVE
CHICAGO IL
60657-4002
US

IV. Provider business mailing address

701 S CARPENTER ST UNIT D
CHICAGO IL
60607-3725
US

V. Phone/Fax

Practice location:
  • Phone: 773-871-0302
  • Fax:
Mailing address:
  • Phone: 630-456-2162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037352
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: