Southern Illinois University Edwardsville School Of Dental Medicine | |
411 E Broadway E St Louis IL 62201-2904 | |
(618) 682-8318 | |
(618) 474-7029 |
Full Name | Southern Illinois University Edwardsville School Of Dental Medicine |
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Speciality | Dentist |
Location | 411 E Broadway, E St Louis, Illinois |
Authorized Official Name and Position | Dennis E Savoca (ASSOCIATE DEAN FOR CLINICAL AFFAIRS) |
Authorized Official Contact | 6184747090 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Southern Illinois University Edwardsville School Of Dental Medicine 2800 College Ave Alton IL 62002-4700 Ph: (618) 474-7090 | Southern Illinois University Edwardsville School Of Dental Medicine 411 E Broadway E St Louis IL 62201-2904 Ph: (618) 682-8318 |
NPI Number | 1760467146 |
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Provider Enumeration Date | 12/08/2005 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1760467146 | NPI | - | NPPES |
19018978 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | 19018978 (Illinois) | Primary |