Provider Demographics
NPI:1124011358
Name:DOVGAN, JOHN WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:DOVGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 E THUNDERBIRD RD
Mailing Address - Street 2:#101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5719
Mailing Address - Country:US
Mailing Address - Phone:602-867-1899
Mailing Address - Fax:602-867-1888
Practice Address - Street 1:3841 E THUNDERBIRD RD
Practice Address - Street 2:#101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5719
Practice Address - Country:US
Practice Address - Phone:602-867-1899
Practice Address - Fax:602-867-1888
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD4018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist