Healthcare Provider Details

I. General information

NPI: 1043127020
Provider Name (Legal Business Name): GRAYSLAKE DENTAL STUDIO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18931 W WASHINGTON ST STE 300
GRAYSLAKE IL
60030-1101
US

IV. Provider business mailing address

309 ESSEX CT
BLOOMINGDALE IL
60108-3017
US

V. Phone/Fax

Practice location:
  • Phone: 608-306-1531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. HENRY JAMES SCHELLHORN
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 608-306-1531