Provider Demographics
NPI:1639218787
Name:GOVONI, MONIKA MAGDALENA (DDS)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:MAGDALENA
Last Name:GOVONI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MONIKA
Other - Middle Name:MAGDALENA
Other - Last Name:WIETECHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:946 N WINCHESTER #3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:312-758-7338
Mailing Address - Fax:
Practice Address - Street 1:2410 N CLARK
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-248-8836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist