Individual
JAY GOSALIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
251 E HURON ST, CHICAGO, IL 60611
(312) 926-2000
Mailing address
60 PELICAN BAY, ROSELLE, IL 60172-4726
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.031670
IL
Other
Enumeration date
03/25/2018
Last updated
06/06/2018
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