Provider Demographics
NPI:1780049866
Name:MCLAUGHLIN, SAMANTHA RENAE (RDH)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:RENAE
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:CATLIN
Mailing Address - State:IL
Mailing Address - Zip Code:61817-0212
Mailing Address - Country:US
Mailing Address - Phone:217-260-9053
Mailing Address - Fax:
Practice Address - Street 1:614 N GILBERT ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3940
Practice Address - Country:US
Practice Address - Phone:217-442-8790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020014815124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist