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.
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.
This page was last updated on: 3/30/2025
NPI Synchronization or Removal
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