Healthcare Provider Details

I. General information

NPI: 1962729913
Provider Name (Legal Business Name): DDS SPECIALTY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 S ROSELLE RD
SCHAUMBURG IL
60193-3960
US

IV. Provider business mailing address

1061 S ROSELLE RD
SCHAUMBURG IL
60193-3960
US

V. Phone/Fax

Practice location:
  • Phone: 847-301-0400
  • Fax: 847-301-7576
Mailing address:
  • Phone: 847-301-0400
  • Fax: 847-301-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. GLENN H SHULKIN
Title or Position: PRESIDENT
Credential: D.D.S
Phone: 847-301-0400