Sang Soo John Grzesik, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

3001 'A' 6TH St
NHC Great Lakes
Great Lakes, IL 60088

Phone

(847) 688-3331

Fax

(847) 688-6259

NPI assigned

Jan 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193356800000",
    "number": "1952371031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 'A' 6TH ST",
            "address_2": "NHC GREAT LAKES",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "60088",
            "telephone_number": "847-688-3331",
            "fax_number": "847-688-6259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 'A' 6TH ST",
            "address_2": "NHC GREAT LAKES",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "60088",
            "telephone_number": "847-688-3331",
            "fax_number": "847-688-6259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRZESIK",
        "first_name": "SANG SOO",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2007-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edward NMN Goldsborough IV, IDC
• Eric Martin Gomez, M.D.
• Chase James Gottschalk, DDS
• Martin Louis Gottstine, DDS
• David Lawrence Green, D.D.S.
• Kelsie Lynn Hammac
• Peter Jerome Hammes, DDS
• Roger Edward Hanks, DDS
• Jennifer Harte, DDS, MS
• John Paul Haxton, D.D.S

• General Practice Dentistry in Great Lakes, IL
• Providers in Great Lakes, 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 Oct 26, 2007; 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.