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General NPI Number Information
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NPI Number | 1891656252
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Entity Type | Organization
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Legal Business Name | LONG GROVE DENTAL, PC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 4160 IL-83 102
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City | LONG GROVE
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State | IL
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Zip | 60047
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Country | US
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Telephone | 847-634-0808
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Fax | 847-634-1654
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Provider Business Mailing Address
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Address Line | 4160 IL-83 102
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City | LONG GROVE
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State | IL
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Zip | 60047
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Country | US
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Telephone | 847-634-0808
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Fax | 847-634-1654
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Authorized Official
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Title or Position | DIRECTOR - REVENUE CYCLE MANAGEMENT
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Name | THOMAS SIMCOX
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Credential |
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Telephone | 201-400-1481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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