Healthcare Provider Details

I. General information

NPI: 1063863322
Provider Name (Legal Business Name): CHAU MCGOVERN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15761 SHERIDAN ST STE A
SOUTHWEST RANCHES FL
33331-3486
US

IV. Provider business mailing address

15761 SHERIDAN ST STE A
SOUTHWEST RANCHES FL
33331-3486
US

V. Phone/Fax

Practice location:
  • Phone: 954-799-6212
  • Fax: 954-250-6520
Mailing address:
  • Phone: 954-799-6212
  • Fax: 954-250-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN21989
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21989
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: