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Contact Information

SOUTHERN ILLINOIS UNIVERSITY CARBONDALE DENTAL SEALANT PROGRAM
1365 DOUGLAS DR RM 18
CASA, SAH, MC 6615
CARBONDALE, IL62901-2583
 Phone: 618-453-7211
 Fax: 618-453-7020
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dental Public Health

1223D0001X
 

Dental

261QD0000X
Indicates primary specialty

NPI Profile & details for SOUTHERN ILLINOIS UNIVERSITY CARBONDALE DENTAL SEALANT PROGRAM

NPI # 1053582189
LBN Legal business name SOUTHERN ILLINOIS UNIVERSITY CARBONDALE DENTAL SEALANT PROGRAM
Authorized official JENNIFER KREID - (DSGP PROGRAM COORDINATOR)
Entity Organization
Organization subpart 1 Yes
Enumeration date 03/17/2008
Last updated 06/03/2025 - More than a year ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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