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Organization
GRACE H CHUNG, PLLC
Active
Organization
GRACE H CHUNG, PLLC
Active
Other names
Smile Shop Dental and Facial Aesthetics
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE CHUNG DDS (OWNER DENTIST)
(702) 444-7771
Entity
Organization
Contact information
Practice address
680 S GREEN VALLEY PKWY STE 100, HENDERSON, NV 89052-0438
(702) 444-7771
(702) 444-7934
Mailing address
680 S GREEN VALLEY PKWY STE 100, HENDERSON, NV 89052-0438
(702) 444-7771
(702) 444-7934
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6572
NV
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003265091
NPI TYPE 1
—
01
—
1295139905
NPI TYPE 1
—
Enumeration date
01/13/2016
Last updated
01/08/2024
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