OrganizationActive
Southern Illinois University Carbondale Dental Sealant Program
NPI 1053582189 · Public Health Dentistry · Carbondale, IL
Provider details
- NPI number
- 1053582189
- Entity type
- Organization
- Primary specialty
- Public Health DentistryDental Providers
- Parent organization
- Southern Illinois University Carbondale
- Organization subpart
- Yes
- Authorized official
- Jennifer Kreid, Dsgp Program Coordinator(618) 453-8823
Specialties & taxonomies
Dental Providers
- Dental Clinic/Center261QD0000X
Ambulatory Health Care Facilities
Practice location
1365 Douglas Dr Rm 18
Casa, Sah, Mc 6615
Carbondale, IL 62901-2583
Phone: (618) 453-7211
Fax: (618) 453-7020
Approximate (ZIP-level) locationGet directions
Mailing address
1365 Douglas Dr Rm 18
Carbondale, IL 62901-2583
Other names (DBA / former)
- Other name
- Childrens Healthcare Found Grant
Registry dates
- Enumerated
- 2008-03-17
- Last updated
- 2025-06-03
- Certified
- 2025-06-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.