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General NPI Number Information
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NPI Number | 1013147024
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Entity Type | Organization
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Legal Business Name | YUMMY DENTAL
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 07/24/2009
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Provider Practice Location Address
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Address Line | 3500 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60657-1104
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Country | US
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Telephone | 312-773-7994
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60657-1104
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Country | US
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Telephone | 312-773-7994
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Fax |
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | DR. GRACE YUM
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Credential |
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Telephone | 312-988-9855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 021002143
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License Number State | IL
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