MEDICARE: DR. JOHN DREW GORRELL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1194731877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DREW GORRELL DDS

Provider Business Mailing Address
First Line	:	958 ELK GROVE TOWN CTR
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3754
Country	:	US
Telephone Number	:	847-364-5100
Fax Number	:	847-364-9807

Provider Business Practice Location Address
First Line	:	958 ELK GROVE TOWN CTR
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3754
Country	:	US
Telephone Number	:	847-364-5100
Fax Number	:	847-364-9807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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