Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

SAMUEL LEE DONAVON DMD
NPI 1164357737
Dentist in Glen Carbon, IL

Q: What is Samuel Donavon's NPI number?

The NPI number for Samuel Donavon is 1164357737. It was assigned to this individual provider in the NPPES registry on June 16, 2026.

Q: What is Samuel Donavon's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: When was this NPI record last updated?

The NPPES record for Samuel Donavon was last updated on June 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 52 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 16, 2026

21 GLEN ED PROFESSIONAL PARK, GLEN CARBON, IL 62034(618) 656-0608(618) 656-0615 Get Directions Write a Review

NPPES record added: June 16, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Samuel Lee Donavon Dmd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMUEL LEE DONAVON DMD (NPI 1164357737) is an individual dentist in Glen Carbon, Illinois, licensed in Illinois (01903713) and active in the NPI registry since June 2026.

NPPES Registry Identity

NPI1164357737

Entity TypeIndividualMale

Primary Taxonomy122300000X

Provider Legal NameSAMUEL LEE DONAVONCredential: DMD

Location Address21 GLEN ED PROFESSIONAL PARKGlen Carbon, IL 62034-3333

Mailing Address21 Glen Ed Professional ParkGlen Carbon, IL 62034-3333 · (618) 656-0608 · Fax (618) 656-0615

Phone(618) 656-0608

Fax(618) 656-0615

Sole ProprietorYes

Enumeration DateJune 16, 2026

NPPES CertifiedJune 16, 2026

✔ NPI 1164357737 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in IL · 01903713

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

21 GLEN ED PROFESSIONAL PARK, Glen Carbon, IL 62034

Open in Google Maps ↗

Other Identifiers 1

Other019037193IL · General Dentist

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CHRISTA D HOPP DMD

Dentist (General Practice)