Healthcare Provider Details

I. General information

NPI: 1073634051
Provider Name (Legal Business Name): JAMES W MCGOUGH DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SULLIVAN RD
AURORA IL
60506-1465
US

IV. Provider business mailing address

345 SULLIVAN RD
AURORA IL
60506-1465
US

V. Phone/Fax

Practice location:
  • Phone: 630-892-1515
  • Fax: 630-892-1583
Mailing address:
  • Phone: 630-892-1515
  • Fax: 630-892-1583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. JAMES WALTER MCGOUGH
Title or Position: PRESIDENT
Credential: DDS
Phone: 630-892-1515