Provider Demographics
NPI:1295139905
Name:CHUNG, GRACE (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 S GREEN VALLEY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-0438
Mailing Address - Country:US
Mailing Address - Phone:702-444-7771
Mailing Address - Fax:702-444-7934
Practice Address - Street 1:680 S GREEN VALLEY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-0438
Practice Address - Country:US
Practice Address - Phone:702-444-7771
Practice Address - Fax:702-444-7934
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV65721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice