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General NPI Number Information
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NPI Number | 1780049866
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Entity Type | Individual
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Provider Name | SAMANTHA RENAE MCLAUGHLIN RDH
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Gender | Female
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 03/08/2018
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Provider Practice Location Address
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Address Line | 614 N GILBERT ST
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City | DANVILLE
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State | IL
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Zip | 61832-3940
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Country | US
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Telephone | 217-442-8790
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 212
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City | CATLIN
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State | IL
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Zip | 61817-0212
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Country | US
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Telephone | 217-260-9053
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 020014815
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License Number State | IL
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