Provider Demographics
NPI:1932270121
Name:BINCH, SAMUEL REESE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:REESE
Last Name:BINCH
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:SKIP
Other - Middle Name:
Other - Last Name:BINCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2914 CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-6163
Mailing Address - Country:US
Mailing Address - Phone:217-359-8008
Mailing Address - Fax:217-359-5090
Practice Address - Street 1:2914 CROSSING CT
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-6163
Practice Address - Country:US
Practice Address - Phone:217-359-8008
Practice Address - Fax:217-359-5090
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice