Healthcare Provider Details

I. General information

NPI: 1194241000
Provider Name (Legal Business Name): KELSEY ESPOSITO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PENNSYLVANIA AVE STE 1W
GLEN ELLYN IL
60137-4170
US

IV. Provider business mailing address

550 PENNSYLVANIA AVE
GLEN ELLYN IL
60137-8303
US

V. Phone/Fax

Practice location:
  • Phone: 630-469-5545
  • Fax: 630-469-5589
Mailing address:
  • Phone: 630-469-5545
  • Fax: 630-469-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019031211
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: