Provider Demographics
NPI:1457507261
Name:GOVOSTES, JOHN NICHOLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NICHOLAS
Last Name:GOVOSTES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 COMMERCIAL ST
Mailing Address - Street 2:APT 301
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-1295
Mailing Address - Country:US
Mailing Address - Phone:617-833-3555
Mailing Address - Fax:
Practice Address - Street 1:357 COMMERCIAL ST
Practice Address - Street 2:APT 301
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1295
Practice Address - Country:US
Practice Address - Phone:617-833-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice