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1111 East Walnut Street Carbondale IL 62901 | |
| (618) 529-2471 | |
| (618) 529-2482 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1111 East Walnut Street, Carbondale, Illinois |
| Authorized Official Name and Position | Richard Workman (OWNER/PC PRESENDT) |
| Authorized Official Contact | 2175405100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1111 E Walnut Ste A1 Carbondale IL 62901 Ph: (618) 529-2471 | 1111 East Walnut Street Carbondale IL 62901 Ph: (618) 529-2471 |
| NPI Number | 1184737363 |
|---|---|
| Provider Enumeration Date | 08/15/2006 |
| Last Update Date | 08/10/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184737363 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019-015765 (Illinois) | Primary |
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