MEDICARE: MICHAEL A. ESPOSITO DDS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019-019100	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	019-019100	OTHER	IL	STATE DENTAL LICENSE

General Provider Information

NPI Number	:	1386095933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL A. ESPOSITO DDS, P.C.

Provider Business Mailing Address
First Line	:	5646 SAINT CHARLES RD
Second Line	:	SUITE C
City	:	BERKELEY
State	:	IL
Zip	:	60163-1148
Country	:	US
Telephone Number	:	708-544-9773
Fax Number	:

Provider Business Practice Location Address
First Line	:	5646 SAINT CHARLES RD
Second Line	:	SUITE C
City	:	BERKELEY
State	:	IL
Zip	:	60163-1148
Country	:	US
Telephone Number	:	708-544-9773
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL A ESPOSITO
Credential	:	DDS
Telephone Number	:	708-544-9773

Provider Enumeration Date	:	06/24/2016
Last Update Date	:	06/24/2016

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