Provider Demographics
NPI:1811335730
Name:KOCMOND, YASMIN VANESSA (DDS)
Entity type:Individual
Prefix:DR
First Name:YASMIN
Middle Name:VANESSA
Last Name:KOCMOND
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 1:769 N KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-3850
Mailing Address - Country:US
Mailing Address - Phone:847-702-9577
Mailing Address - Fax:
Practice Address - Street 1:2024 OAKTON ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1958
Practice Address - Country:US
Practice Address - Phone:847-292-6540
Practice Address - Fax:847-292-0771
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190294291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice