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General NPI Number Information
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NPI Number | 1497737175
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Entity Type | Individual
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Provider Name | GLORIA G JOHN DDS
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Gender | Female
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 1803 S THROOP ST
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City | CHICAGO
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State | IL
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Zip | 60608-3865
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Country | US
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Telephone | 312-633-0400
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Fax | 312-633-9460
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Provider Business Mailing Address
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Address Line | 233 E 13TH ST #1309
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City | CHICAGO
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State | IL
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Zip | 60605-3237
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Country | US
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Telephone | 312-493-6497
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019026407
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License Number State | IL
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