Healthcare Provider Details

I. General information

NPI: 1710080106
Provider Name (Legal Business Name): ARCHIE A ESTEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 NORTH SEYMOUR AVENUE
MUNDELEIN IL
60060-2305
US

IV. Provider business mailing address

323 NORTH SEYMOUR AVENUE
MUNDELEIN IL
60060-2305
US

V. Phone/Fax

Practice location:
  • Phone: 847-566-7522
  • Fax: 847-566-7531
Mailing address:
  • Phone: 847-566-7522
  • Fax: 847-566-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: