Individual
GUSTAVO LAWRENCE GOVIN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
18 DUNLOUP, SHAWNEE, OK 74804
(405) 275-1252
(405) 275-4292
Mailing address
18 DUNLOUP, SHAWNEE, OK 74804
(405) 275-1252
(405) 275-4292
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3739
OK
Other
Enumeration date
08/22/2006
Last updated
07/08/2007
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