Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Other names
Delmar Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MCCULLEY (CHIEF EXECUTIVE OFFICER)
(618) 332-0649
Entity
Organization
Contact information
Practice address
1820 DELMAR AVE, GRANITE CITY, IL 62040-4507
(618) 877-4489
(618) 877-4487
Mailing address
8080 STATE ST, EAST SAINT LOUIS, IL 62203-1808
(618) 397-3303
(618) 397-3303
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
12/07/2007
Last updated
04/12/2011
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