Provider Demographics
NPI:1326878372
Name:NGM DENTAL LLC
Entity type:Organization
Organization Name:NGM DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCCULLOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-892-4595
Mailing Address - Street 1:820 E 87TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6256
Mailing Address - Country:US
Mailing Address - Phone:773-488-3738
Mailing Address - Fax:
Practice Address - Street 1:820 E 87TH ST STE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6256
Practice Address - Country:US
Practice Address - Phone:773-488-3738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental