Provider Demographics
NPI:1437359932
Name:KAMINSKI, JOHN RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAYMOND
Last Name:KAMINSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12016 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:IL
Mailing Address - Zip Code:60034-8892
Mailing Address - Country:US
Mailing Address - Phone:815-648-4095
Mailing Address - Fax:815-648-2881
Practice Address - Street 1:12016 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:IL
Practice Address - Zip Code:60034-8892
Practice Address - Country:US
Practice Address - Phone:815-648-4095
Practice Address - Fax:815-648-2881
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice