| Illinois Children's Healthcare Foundation Dental Grant Project | |
|
1365 Douglas Dr College Of Applied Sciences/school Of Allied Health Carbondale IL 62901-6615 | |
| (618) 453-7241 | |
| (618) 453-7020 |
| Full Name | Illinois Children's Healthcare Foundation Dental Grant Project |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1365 Douglas Dr, Carbondale, Illinois |
| Authorized Official Name and Position | Ronda Demattei (ASSOC. PROF./DENTAL HYGIENE PROGRAM) |
| Authorized Official Contact | 6184537298 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illinois Children's Healthcare Foundation Dental Grant Project 1365 Douglas Dr College Of Applied Sciences/school Of Allied Health Carbondale IL 62901-6615 Ph: (618) 453-7241 | Illinois Children's Healthcare Foundation Dental Grant Project 1365 Douglas Dr College Of Applied Sciences/school Of Allied Health Carbondale IL 62901-6615 Ph: (618) 453-7241 |
| NPI Number | 1720250939 |
|---|---|
| Provider Enumeration Date | 03/27/2008 |
| Last Update Date | 03/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720250939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (Illinois) | Primary |
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