| Community Dental Center | |
|
1365 Douglas Drive Carbondale IL 62901 | |
| (618) 453-2353 | |
| Not Available |
| Full Name | Community Dental Center |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1365 Douglas Drive, Carbondale, Illinois |
| Authorized Official Name and Position | Lauren Cripps (DENTIST) |
| Authorized Official Contact | 6184532353 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Dental Center 1365 Douglas Drive Carbondale IL 62901 Ph: (618) 453-2353 | Community Dental Center 1365 Douglas Drive Carbondale IL 62901 Ph: (618) 453-2353 |
| NPI Number | 1962674788 |
|---|---|
| Provider Enumeration Date | 04/01/2008 |
| Last Update Date | 09/24/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962674788 | NPI | - | NPPES |
| 1184615866 | Medicaid | IL | |
| 019.032439 | Medicaid | IL | |
| 1295716959 | Medicaid | IL | |
| 1023008364 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019024395 (Illinois) | Primary |
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