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General NPI Number Information
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NPI Number | 1548947815
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Entity Type | Individual
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Provider Name | JAMES MIGUEL COVINGTON DDS
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Gender | Male
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 5301 STATE ROUTE 251 STE A
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City | PERU
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State | IL
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Zip | 61354-9317
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Country | US
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Telephone | 779-601-6065
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Fax |
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Provider Business Mailing Address
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Address Line | 11751 S ARTESIAN AVE
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City | CHICAGO
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State | IL
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Zip | 60655-1515
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Country | US
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Telephone | 773-952-1716
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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 | 019034434
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License Number State | IL
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