Individual
KELLY MCGOWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3250 W 111TH ST, CHICAGO, IL 60655-2729
(773) 232-5383
Mailing address
3250 W 111TH ST, CHICAGO, IL 60655-2729
(773) 232-5383
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.030626
IL
Other
Enumeration date
07/27/2016
Last updated
06/17/2022
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