MEDICARE: PRASAD B GONAVARUM D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1174512339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRASAD B GONAVARUM D.D.S.

Provider Business Mailing Address
First Line	:	7439 PIPERS WAY
Second Line	:	APT # 2
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-4050
Country	:	US
Telephone Number	:	630-271-1687
Fax Number	:

Provider Business Practice Location Address
First Line	:	2413 S STATE ST
Second Line	:	IDEAL DENTAL CENTER
City	:	CHICAGO
State	:	IL
Zip	:	60616-2311
Country	:	US
Telephone Number	:	312-528-1800
Fax Number	:	312-528-1881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/09/2007

Similar Medicare Providers

1831239458 — IDEAL PHARMACY
Practice Location Address:

2413 S STATE ST
CHICAGO, IL
60616-2311

Practice Phone: 312-225-6803
Practice Fax: 312-225-6527

1578886248 — DENTAL HEALTH CENTER LTD
Practice Location Address:

2413 S STATE ST
CHICAGO, IL
60616-2311

Practice Phone: 312-949-9000
Practice Fax:

1013231679 — MR. NATU J PATEL RPH
Practice Location Address:

2413 S STATE ST
CHICAGO, IL
60616-2311

Practice Phone: 312-225-6803
Practice Fax: 312-225-6527

1700309648 — FTDC LTD
Practice Location Address:

2413 S STATE ST
CHICAGO, IL
60616-2311

Practice Phone: 312-949-9000
Practice Fax:

1154202661 — LESLIE LOPEZ DNP, FNP- BC
Practice Location Address:

1720 S MICHIGAN AVE APT 2311
CHICAGO, IL
60616-4855

Practice Phone: 708-910-4099
Practice Fax:

1467056523 — SARA BIELA PHARM.D.
Practice Location Address:

209 CHICAGO AVE
GOSHEN, IN
46526-2311

Practice Phone: 574-534-9223
Practice Fax:

Directions to “ PRASAD B GONAVARUM D.D.S.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.