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Individual

DR. JOHN KENNETH FAVALE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1604 CHICAGO AVE, EVANSTON, IL 60201-6017
(847) 866-8844
Mailing address
404 ADELPHIA AVE, LAKE BLUFF, IL 60044-1502
(847) 295-6979

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
IL

Other

Enumeration date
09/29/2006
Last updated
07/08/2007
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