Grand Dental Care, LTD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GRAND DENTAL CARE, LTD

Practice address

1800 Grand Ave
Waukegan, IL 60085-3582

Phone

(847) 336-4180

Fax

(847) 336-4190

NPI assigned

Mar 9, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jae Myung Shim, DDSNPI 1669504221

Title

President

Phone

(847) 336-4180

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jae Myung Shim, DDS

  • General Practice Dentistry
  • Waukegan, IL
  • NPI 1669504221
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366574923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600853582",
            "telephone_number": "847-336-4180",
            "fax_number": "847-336-4190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600853582",
            "telephone_number": "847-336-4180",
            "fax_number": "847-336-4190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND DENTAL CARE, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHIM",
        "authorized_official_first_name": "JAE",
        "authorized_official_middle_name": "MYUNG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-336-4180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102511",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hillary Matyl Gorin
• Diane Marie Gorman I, LCSW
• Ana Gossman
• Marcus Gottlieb, DDS
• Michelle Marie Grace
• Morris Andrell Gray
• Alexandria Green Cowlishaw, LCSW
• Antoinette Green, FNP-BC
• Cenoa Green
• Kari Marie Green

• General Practice Dentistry in Waukegan, IL
• Providers in Waukegan, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.