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General NPI Number Information
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NPI Number | 1184785800
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Entity Type | Organization
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Legal Business Name | G G FAMILY DENTAL CARE PC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 1275 E BELVIDERE RD STE 202
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City | GRAYSLAKE
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State | IL
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Zip | 60030
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Country | US
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Telephone | 847-548-5750
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Fax | 847-548-5752
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Provider Business Mailing Address
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Address Line | 1275 E BELVIDERE RD STE 202
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City | GRAYSLAKE
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State | IL
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Zip | 60030
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Country | US
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Telephone | 847-548-5750
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Fax | 847-548-5752
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. NADIA GERMAN
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Credential | DMD
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Telephone | 847-548-5750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19026229
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19026228
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License Number State | IL
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