Healthcare Provider Details

I. General information

NPI: 1609046705
Provider Name (Legal Business Name): SAM DAUAHERA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 W TOUHY AVE
CHICAGO IL
60646-1105
US

IV. Provider business mailing address

6225 W TOUHY AVE
CHICAGO IL
60646-1105
US

V. Phone/Fax

Practice location:
  • Phone: 773-631-8717
  • Fax: 773-631-7781
Mailing address:
  • Phone: 773-631-8717
  • Fax: 773-631-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019027577
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: