Samantha Kay Gross, DMD
Individual provider Active NPI General Practice Dentistry · Du Quoin, IL
NPI 1235869199 · NPPES record last updated Jun 14, 2022
Key facts
- NPI
- 1235869199
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019.033723 (IL)
- Practice address
- 1226 S Washington St
Du Quoin, IL 62832-3853 - Phone
- (618) 542-8832
- NPI assigned
- Jun 14, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.033723 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Duquoin Dental Associates, LTD. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.033723 | IL | Yes |
Addresses
Primary practice location
1226 S Washington St
Du Quoin, IL 62832-3853
Mailing address
8490 Emling Rd
Du Quoin, IL 62832-3808
Phone (618) 318-6112
Other providers in Du Quoin, IL
- Carolyn Celeste Gibson
- Gold Plate Program of Perry County
- Jacqueline Gomes
- Ezra Grimm
- Anita Jo Gross
- T'Aira Hampleman
- Elizabeth L. Harbison
- Angela Rae Harsy
- Shelby Hart
- Robert Erhardt Heisner II
All providers in Du Quoin, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.