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General NPI Number Information
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NPI Number | 1568395622
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Entity Type | Individual
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Provider Name | MICHAEL PARK DDS
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Gender | Male
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Dates
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Enumeration Date | 06/06/2026
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Last Update Date | 06/06/2026
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Provider Practice Location Address
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Address Line | 3001 GREEN BAY RD
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-3048
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Country | US
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Telephone | 224-610-4846
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Fax |
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Provider Business Mailing Address
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Address Line | 2010 KENTUCKY AVE
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City | GREAT LAKES
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State | IL
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Zip | 60088-4212
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Country | US
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Telephone | 626-372-6593
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14290135-8903
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14290135-9926
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License Number State | UT
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