NPIMap

Organization Active NPI

Grace H Chung, PLLC

Doing business as Smile Shop Dental and Facial Aesthetics

  • Dental Clinic/Center
  • Henderson, NV
National Provider Identifier
1760848311
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
6572 Issued in NV
Legal business name
GRACE H CHUNG, PLLC
Doing business as
Smile Shop Dental and Facial Aesthetics
Practice address
680 S Green Valley Pkwy Ste 100
Henderson, NV 89052-0438
Phone
(702) 444-7771
Fax
(702) 444-7934
NPI assigned
Jan 13, 2016
Last updated
Jan 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Authorized official

Name
Grace Chung, DDSNPI 1295139905
Title
Owner Dentist
Phone
(702) 444-7771

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Dental Clinic/Center 261QD0000X 6572 NV Primary

Addresses

Primary practice location

680 S Green Valley Pkwy Ste 100
Henderson, NV 89052-0438

Mailing address

680 S Green Valley Pkwy Ste 100
Henderson, NV 89052-0438
Phone (702) 444-7771

Other identifiers 2

IdentifierTypeStateIssuer
1003265091OtherNPI TYPE 1
1295139905OtherNPI TYPE 1

Other names 1

  • Smile Shop Dental and Facial Aesthetics Doing business as

National Provider Directory

National Provider Directory

Locations

10960 S Eastern Ave
Ste 112
Henderson, NV 89052
Phone (702) 444-7771

680 S Green Valley Pkwy
Ste 100
Henderson, NV 89052
Phone (702) 444-7771

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1452643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1760848311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 S GREEN VALLEY PKWY STE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890520438",
            "telephone_number": "702-444-7771",
            "fax_number": "702-444-7934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 S GREEN VALLEY PKWY STE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890520438",
            "telephone_number": "702-444-7771",
            "fax_number": "702-444-7934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE H CHUNG, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-13",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "CHUNG",
        "authorized_official_first_name": "GRACE",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "702-444-7771",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NV",
            "license": "6572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1003265091",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1295139905",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile Shop Dental and Facial Aesthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; 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.