SOUTHERN ILLINOIS UNIVERSITY CARBONDALE is a dental clinic center in Carbondale, IL. SOUTHERN ILLINOIS UNIVERSITY CARBONDALE NPI is 1720250939. The provider is registered as an organization entity type.
The provider Is Doing Business As Illinois Children's Healthcare Foundation Dental Grant Project.
The provider's business location address is:
1365 DOUGLAS DR
COLLEGE OF APPLIED SCIENCES/SCHOOL OF ALLIED HEALTH
CARBONDALE, IL
ZIP 62901-615
Phone: (618) 453-7241
Fax: (618) 453-7020
The provider's authorized official is Ronda Demattei .
The authorized official title is Assoc. Prof./dental Hygiene Program and has the following contact phone number (618) 453-7298.
The CLIA number assigned to this NPI record is 14D0647032 - public health laboratories with a certificate type of Certificate of Compliance.
The enumeration date for this NPI number is 3/27/2008 and was last updated on 3/27/2008.