MEDICARE: NEW SMILE DENTAL CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1336903442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW SMILE DENTAL CARE, LLC

Provider Business Mailing Address
First Line	:	33 W HIGGINS RD STE 4080
Second Line	:
City	:	SOUTH BARRINGTON
State	:	IL
Zip	:	60010-9123
Country	:	US
Telephone Number	:	224-802-8441
Fax Number	:	224-802-8386

Provider Business Practice Location Address
First Line	:	33 W HIGGINS RD STE 4080
Second Line	:
City	:	SOUTH BARRINGTON
State	:	IL
Zip	:	60010-9123
Country	:	US
Telephone Number	:	224-802-8441
Fax Number	:	224-802-8386

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. YONG SUK CHANG
Credential	:	DDS
Telephone Number	:	847-873-3359

Provider Enumeration Date	:	02/08/2024
Last Update Date	:	02/09/2024

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