MEDICARE: JOHN FRANCIS MCGOWAN

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	BM3174098	IL

General Provider Information

NPI Number	:	1922397884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN FRANCIS MCGOWAN

Provider Business Mailing Address
First Line	:	3838 W 111TH ST
Second Line	:	SUITE 105W
City	:	CHICAGO
State	:	IL
Zip	:	60655-4095
Country	:	US
Telephone Number	:	773-779-1415
Fax Number	:	773-779-1415

Provider Business Practice Location Address
First Line	:	3838 W 111TH ST
Second Line	:	SUITE 105W
City	:	CHICAGO
State	:	IL
Zip	:	60655-4095
Country	:	US
Telephone Number	:	773-779-1415
Fax Number	:	773-779-1415

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN F MCGOWAN
Credential	:	DDS
Telephone Number	:	773-779-1415

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	03/31/2011

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