Healthcare Provider Details

I. General information

NPI: 1437359932
Provider Name (Legal Business Name): JOHN RAYMOND KAMINSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12016 PRAIRIE AVE
HEBRON IL
60034-8892
US

IV. Provider business mailing address

12016 PRAIRIE AVE
HEBRON IL
60034-8892
US

V. Phone/Fax

Practice location:
  • Phone: 815-648-4095
  • Fax: 815-648-2881
Mailing address:
  • Phone: 815-648-4095
  • Fax: 815-648-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: