Provider Demographics
NPI:1962729913
Name:DDS SPECIALTY CARE LLC
Entity type:Organization
Organization Name:DDS SPECIALTY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHULKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-301-0400
Mailing Address - Street 1:1061 S ROSELLE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3960
Mailing Address - Country:US
Mailing Address - Phone:847-301-0400
Mailing Address - Fax:847-301-7576
Practice Address - Street 1:1061 S ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3960
Practice Address - Country:US
Practice Address - Phone:847-301-0400
Practice Address - Fax:847-301-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty