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Organization
SIU DENTAL ASSOCIATES
Active
Organization
SIU DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH NOEL PHELPS (BUSINESS MANAGER)
(618) 474-7104
Entity
Organization
Contact information
Practice address
195 UNIVERSITY PARK DR, EDWARDSVILLE, IL 62025-3645
(618) 650-5781
(618) 650-5790
Mailing address
2800 COLLEGE AVE, BLDG 273, ALTON, IL 62002-4700
(618) 474-7100
(618) 474-7150
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
Other
Enumeration date
03/19/2021
Last updated
09/19/2024
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