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Organization
SOUTHERN ILLINOIS UNIVERSITY EDWARDSVILLE SCHOOL OF DENTAL MEDICINE
Active
Organization
SOUTHERN ILLINOIS UNIVERSITY EDWARDSVILLE SCHOOL OF DENTAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBRA M SCHWENK DMD (ASSOCIATE DEAN FOR CLINICAL AFFAIRS)
(618) 474-7080
Entity
Organization
Contact information
Practice address
2800 COLLEGE AVE, ALTON, IL 62002-4700
(618) 474-7080
(618) 474-7029
Mailing address
2800 COLLEGE AVE, ALTON, IL 62002-4700
(618) 474-7080
(618) 474-7029
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19018978
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19018978
—
IL
Enumeration date
12/08/2005
Last updated
07/10/2007
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