| University Place Dental | |
|
1366 E Main Carbondale IL 62901 | |
| (618) 549-0208 | |
| (618) 549-0182 |
| Full Name | University Place Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1366 E Main, Carbondale, Illinois |
| Authorized Official Name and Position | Amy Kroeger (INS COOD) |
| Authorized Official Contact | 2175405100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| University Place Dental 1366 E Main Carbondale IL 62901 Ph: (618) 549-0208 | University Place Dental 1366 E Main Carbondale IL 62901 Ph: (618) 549-0208 |
| NPI Number | 1487867750 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 05/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487867750 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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