Provider Demographics
NPI:1184834996
Name:PROMPTON, JACQUELINE SUNJA (DDS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUNJA
Last Name:PROMPTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:SUNJA
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2400 N ASHLAND AVE. SUITE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:312-500-5001
Mailing Address - Fax:
Practice Address - Street 1:2400 N ASHLAND AVE. SUITE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:312-500-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16294122300000X
IL0190319641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist