14D2188836 CLIA NUMBER - SOUTHERN ILLINOIS UNIV - SCHOOL OF DENTAL MED

Laboratory Demographics

CLIA Number: 14D2188836

Facility Name: SOUTHERN ILLINOIS UNIV - SCHOOL OF DENTAL MED

Facility Address:
2800 COLLEGE AVE
ALTON, IL
ZIP 62002
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Facility Phone Number: 618 474-7100

Facility Type: School/Student Health Service

Certificate Type: Certificate of Compliance

NPI Number: 1215912696

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	14D2188836
LAB Type	School/Student Health Service
Facility Name	SOUTHERN ILLINOIS UNIV - SCHOOL OF DENTAL MED
Street	2800 COLLEGE AVE
City	ALTON
State	IL
ZIP	62002
Phone	618 474-7100
CertificateType	2
CertificateEffectiveDate	6/3/2022
CertificateExpirationDate	6/2/2024
FacilityType	Compliance

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This page was last updated on: 4/23/2024