MEDICARE: DR. DONNA J KOCIM-SAMONSKI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1346381944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA J KOCIM-SAMONSKI DDS

Provider Business Mailing Address
First Line	:	14475 JOHN HUMPHREY DR
Second Line	:	SUITE 310
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-6205
Country	:	US
Telephone Number	:	708-460-1195
Fax Number	:	708-460-1150

Provider Business Practice Location Address
First Line	:	14475 JOHN HUMPHREY DR
Second Line	:	SUITE 310
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-6205
Country	:	US
Telephone Number	:	708-460-1195
Fax Number	:	708-460-1150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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