Provider Demographics
NPI:1164544391
Name:ESBROOK, RANDALL WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:WILLIAM
Last Name:ESBROOK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 12 LAKES CT
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6334
Mailing Address - Country:US
Mailing Address - Phone:847-458-4280
Mailing Address - Fax:
Practice Address - Street 1:8 EXECUTIVE CT
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9531
Practice Address - Country:US
Practice Address - Phone:847-382-0700
Practice Address - Fax:847-382-0707
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019016173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist