Provider Demographics
NPI:1346381944
Name:KOCIM-SAMONSKI, DONNA J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:J
Last Name:KOCIM-SAMONSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14475 JOHN HUMPHREY DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6205
Mailing Address - Country:US
Mailing Address - Phone:708-460-1195
Mailing Address - Fax:708-460-1150
Practice Address - Street 1:14475 JOHN HUMPHREY DR
Practice Address - Street 2:SUITE 310
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6205
Practice Address - Country:US
Practice Address - Phone:708-460-1195
Practice Address - Fax:708-460-1150
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist