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General NPI Number Information
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NPI Number | 1891536975
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Entity Type | Individual
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Provider Name | EILEEN ANN MCGOWAN DMD
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Gender | Female
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 3250 W 111TH ST
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City | CHICAGO
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State | IL
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Zip | 60655-2729
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Country | US
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Telephone | 773-232-5383
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Fax |
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Provider Business Mailing Address
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Address Line | 8867 W 98TH ST
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City | PALOS HILLS
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State | IL
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Zip | 60465-1016
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Country | US
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Telephone | 708-860-0424
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019035143
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License Number State | IL
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