|
| |
|
1365 Douglas Drive Carbondale IL 62901 | |
| (618) 453-2353 | |
| Not Available |
| Full Name | |
|---|---|
| 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 |
|---|---|
1365 Douglas Drive Carbondale IL 62901 Ph: (618) 453-2353 | 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 |
Southern Illinois University Carbondale Dental Sealant Program Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1365 Douglas Dr Rm 18, Casa, Sah, Mc 6615, Carbondale, IL 62901 Phone: 618-453-7211 Fax: 618-453-7020 | |
Oakland Dental Care P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 305 S Oakland Ave, Carbondale, IL 62901 Phone: 618-549-2166 Fax: 618-529-4128 | |
Little Egypt Pediatric Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1255 Cedar Ct, Carbondale, IL 62901 Phone: 618-319-4536 |