Individual
MICHAEL PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3001 GREEN BAY RD, NORTH CHICAGO, IL 60064-3048
(224) 610-4846
Mailing address
2010 KENTUCKY AVE, GREAT LAKES, IL 60088-4212
(626) 372-6593
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
14290135-8903
UT
1223G0001X
General Practice Dentistry
Primary
14290135-9926
UT
Other
Enumeration date
06/06/2026
Last updated
06/06/2026
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