Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1164357737 Individual Practitioner Male Practitioner

Dr. Samuel Lee Donavon , DMD

Dentist • Glen Carbon, IL

Professional Overview & Biography Verified Profile Summary

Dr. Samuel Donavon, DMD is a registered healthcare professional specializing in Dentist in Glen Carbon, IL. Practice services are available at 21 GLEN ED PROFESSIONAL PARK under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

21 Glen Ed Professional Park

Glen Carbon, IL 620343333

Telephone 6186560608
Fax 6186560615
Associated Practice Facility / Clinic
🏢 Sones Family Dental, Llc Facility NPI 1700206406

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Glen Carbon, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 12.1 Yrs
Regional Practice Density
19 Specialists

Practicing in Glen Carbon, IL (4751 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-06-16
Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License IL 01903713

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.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID General Dentist
019037193 (IL)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners
Abby Roth

Dentist

NPI 1134961758
NPI 1588344824

Doctor of Dental Medicine

NPI 1700703840

Doctor of Dental Medicine

Dr. Morgan Mcateer , DMD

Dentist - General Practice

NPI 1881262434

Doctor of Dental Medicine

NPI 1982221313

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active June 16, 2026

NPI status registered as active in NPPES database

📍
Updated Practice Location June 16, 2026

Registered at 21 GLEN ED PROFESSIONAL PARK, GLEN CARBON, IL 620343333 (Tel: 6186560608)

📍
Updated Business Mailing Address June 16, 2026

Registered at 21 GLEN ED PROFESSIONAL PARK, GLEN CARBON, IL 620343333 (Tel: 6186560608)

👤
Provider Name / Credentials Updated June 16, 2026

Recorded as SAMUEL DONAVON, DMD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 16, 2026

Dentist (License #01903713 in IL)

🟢
Initial NPI Registration & Enumeration June 16, 2026

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1164357737
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 16, 2026
Last Update: June 16, 2026
Sole Proprietor: Yes

Mailing Address

21 Glen Ed Professional Park

Glen Carbon, IL 620343333

Phone: 6186560608

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.