Provider Demographics
NPI:1891906285
Name:BOVA, JOHN E (DDS, PC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:BOVA
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16636 107TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8898
Mailing Address - Country:US
Mailing Address - Phone:708-460-1000
Mailing Address - Fax:708-460-1093
Practice Address - Street 1:16636 107TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8898
Practice Address - Country:US
Practice Address - Phone:708-460-1000
Practice Address - Fax:708-460-1093
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190152631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice