Organization
SOUTHERN ILLINOIS UNIVERSITY CARBONDALE
Active
Parent organization
SOUTHERN ILLINOIS UNIVERSITY CARBONDALE
Other names
Community Dental Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHERN ILLINOIS UNIVERSITY CARBONDALE
Authorized official
LAUREN CRIPPS DMD (DENTIST)
(618) 453-2353
Entity
Organization
Contact information
Practice address
1365 DOUGLAS DRIVE, CARBONDALE, IL 62901
(618) 453-2353
Mailing address
1365 DOUGLAS DRIVE, CARBONDALE, IL 62901
(618) 453-2353
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019024395
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019.032439
—
IL
05
—
1023008364
—
IL
05
—
1184615866
—
IL
05
—
1295716959
—
IL
Enumeration date
04/01/2008
Last updated
09/24/2021
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