Provider Demographics
NPI:1679670665
Name:KAMINSKI, JOHN C (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
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 1:880 LEE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6420
Mailing Address - Country:US
Mailing Address - Phone:847-824-7722
Mailing Address - Fax:847-824-7775
Practice Address - Street 1:880 LEE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-6420
Practice Address - Country:US
Practice Address - Phone:847-824-7722
Practice Address - Fax:847-824-7775
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190215481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice