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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