Organization
SOUTHERN ILLINOIS UNIVERSITY CARBONDALE DENTAL SEALANT PROGRAM
Active
Parent organization
SOUTHERN ILLINOIS UNIVERSITY CARBONDALE
Other names
Childrens Healthcare Found Grant
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHERN ILLINOIS UNIVERSITY CARBONDALE
Authorized official
JENNIFER R KREID RDH, PHDH, BSDH (DSGP PROGRAM COORDINATOR)
(618) 453-8823
Entity
Organization
Contact information
Practice address
1365 DOUGLAS DR RM 18, CASA, SAH, MC 6615, CARBONDALE, IL 62901-2583
(618) 453-7211
(618) 453-7020
Mailing address
1365 DOUGLAS DR RM 18, CASA, SAH, MC 6615, CARBONDALE, IL 62901-2583
(618) 453-7211
(618) 453-7020
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
03/17/2008
Last updated
06/03/2025
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