Provider Demographics
NPI:1922397884
Name:JOHN FRANCIS MCGOWAN
Entity Type:Organization
Organization Name:JOHN FRANCIS MCGOWAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-779-1415
Mailing Address - Street 1:3838 W 111TH ST
Mailing Address - Street 2:SUITE 105W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-4095
Mailing Address - Country:US
Mailing Address - Phone:773-779-1415
Mailing Address - Fax:773-779-1415
Practice Address - Street 1:3838 W 111TH ST
Practice Address - Street 2:SUITE 105W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-4095
Practice Address - Country:US
Practice Address - Phone:773-779-1415
Practice Address - Fax:773-779-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBM31740981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty