Individual
DR. JONATHAN L GIFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
435 W PROSPECT AVE, MOUNT PROSPECT, IL 60056-3031
(847) 255-9690
Mailing address
783 MARK AVE, DES PLAINES, IL 60016-1109
(414) 916-2863
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019030941
IL
122300000X
Dentist
DD4038
NM
Other
Enumeration date
01/24/2012
Last updated
03/02/2017
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