Individual
SAMUEL LEE DONAVON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
21 GLEN ED PROFESSIONAL PARK, GLEN CARBON, IL 62034-3333
(618) 656-0608
(618) 656-0615
Mailing address
21 GLEN ED PROFESSIONAL PARK, GLEN CARBON, IL 62034-3333
(618) 656-0608
(618) 656-0615
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
01903713
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019037193
GENERAL DENTIST
IL
Enumeration date
06/16/2026
Last updated
06/16/2026
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