Organization
GRAND DENTAL CARE, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAE MYUNG SHIM DDS (PRESIDENT)
(847) 336-4180
Entity
Organization
Contact information
Practice address
1800 GRAND AVE, WAUKEGAN, IL 60085-3582
(847) 336-4180
(847) 336-4190
Mailing address
1800 GRAND AVE, WAUKEGAN, IL 60085-3582
(847) 336-4180
(847) 336-4190
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102511
—
IL
Enumeration date
03/09/2007
Last updated
08/22/2020
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