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DR. SAM PARK D.D.S.
NPI 1295871267
Dentist - Pediatric Dentistry in Chicago, IL

Active since January 29, 2007Opted out of Medicare · through Nov 12, 2026
2959 S WALLACE ST, CHILDREN'S DENTAL WORLD, CHICAGO, IL 60616(312) 326-5437(312) 842-5338 Get Directions Write a Review

NPPES record last updated: August 6, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Sam Park D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SAM PARK D.D.S. (NPI 1295871267) is an individual pediatric dentistry provider in Chicago, Illinois, licensed in Illinois (021002099) and active in the NPI registry since January 2007. He has opted out of Medicare through November 12, 2026 and remains eligible to order and refer and maintains a secondary practice location in Morton Grove.

NPPES Registry Identity

NPI1295871267
Entity TypeIndividualMale
Primary Taxonomy1223P0221X
Provider Legal NameDR. SAM PARKCredential: D.D.S.
Location Address2959 S WALLACE ST, CHILDREN'S DENTAL WORLDChicago, IL 60616-3034
Mailing Address2959 S Wallace St, Children's Dental WorldChicago, IL 60616-3034 · (312) 326-5437 · Fax (312) 842-5338
Phone(312) 326-5437
Fax(312) 842-5338
Sole ProprietorNo
Enumeration DateJanuary 29, 2007
Last NPPES UpdateAugust 6, 2020
NPPES CertifiedAugust 6, 2020
✔ NPI 1295871267 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License✔ Licensed in IL · 021002099
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
2959 S WALLACE ST, Chicago, IL 60616
Open in Google Maps ↗

Secondary Practice Location 1

Location 15826 Dempster StMorton Grove, IL 60053-3046 · Phone (847) 470-0665

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Sam Park D.d.s. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from November 12, 2018 through November 12, 2026.

Opt-Out Effective DateNovember 12, 2018
Opt-Out In Effect ThroughNovember 12, 2026Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60616 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$94.06 typical visit price
range $60.08 – $183.39
Typical copayment $23.51 (range $15.02 – $45.84)
Most-billed visit code 99203
Established Patient
$74.80 typical visit price
range $18.97 – $148.12
Typical copayment $18.70 (range $4.74 – $37.03)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RAMI MIKATI
Dentist (Pediatric Dentistry)
2959 S WALLACE ST
CHICAGO, IL 60616
Cook County (312) 326-5437
CHILDREN'S DENTAL WORLD, LLC
Dentist (Pediatric Dentistry)
2959 S WALLACE ST
CHICAGO, IL 60616
Cook County (312) 326-5437
VONGLUEKIAT & CHOI LLC
Dentist (General Practice)
2959 S WALLACE ST
CHICAGO, IL 60616
Cook County (312) 791-0920
DR. LEE J. CRISANTI D.D.S.
Dentist
2959 S WALLACE ST
CHICAGO, IL 60616
Cook County (312) 791-0920
BRIDGEPORT DENTAL SPECIALISTS, LLC
Dentist
2959 S WALLACE ST
CHICAGO, IL 60616
Cook County (312) 326-5437
DR. STEVEN VONGLUEKIAT DDS
Dentist
2959 S WALLACE ST
CHICAGO, IL 60616
Cook County (312) 791-0920
BRIDGEPORT DENTAL SPECIALISTS LLC
Dentist (Orthodontics and Dentofacial Orthopedics)
2959 S WALLACE ST
CHICAGO, IL 60616
Cook County (312) 791-0920

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sam Park's NPI number?

The NPI number for Sam Park is 1295871267. It was assigned to this individual provider in the NPPES registry on January 29, 2007.

Where is Sam Park located?

Sam Park practices at 2959 S Wallace St Children's Dental World, Chicago, IL 60616. The listed phone number is (312) 326-5437.

What is Sam Park's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Is Sam Park enrolled in Medicare?

No. Sam Park has opted out of Medicare through November 12, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Sam Park accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and HRI Dental & Vision and 3 other insurers list Sam Park as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sam Park was last updated on August 6, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.