| Southern Illinois University Carbondale Dental Sealant Program | |
|
1365 Douglas Dr Rm 18 Casa, Sah, Mc 6615 Carbondale IL 62901-2583 | |
| (618) 453-7211 | |
| (618) 453-7020 |
| Full Name | Southern Illinois University Carbondale Dental Sealant Program |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1365 Douglas Dr Rm 18, Carbondale, Illinois |
| Authorized Official Name and Position | Faith Miller (DENTAL SEALANT PROGRAM CO-COORDINAT) |
| Authorized Official Contact | 6184537211 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois University Carbondale Dental Sealant Program 1365 Douglas Dr Rm 18 Casa, Sah, Mc 6615 Carbondale IL 62901-2583 Ph: (618) 453-7211 | Southern Illinois University Carbondale Dental Sealant Program 1365 Douglas Dr Rm 18 Casa, Sah, Mc 6615 Carbondale IL 62901-2583 Ph: (618) 453-7211 |
| NPI Number | 1053582189 |
|---|---|
| Provider Enumeration Date | 03/17/2008 |
| Last Update Date | 03/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053582189 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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