Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Southern Illinois University Carbondale

Organization Dental Clinic/Center · NPI 1720250939

Southern Illinois University Carbondale is a Dental Clinic/Center in Carbondale, Illinois. Licensed in Illinois. Registered with an NPI since 2008.

Licensed in
IL
In the registry since
2008
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Practice location Address checks out

1365 Douglas Dr College Of Applied Sciences/school Of Allied Health
Carbondale, IL 62901-6615
Phone: (618) 453-7241
Fax: (618) 453-7020
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dental Clinic/Center (primary) Taxonomy 261QD0000X (IL)

Record details

NPI number1720250939
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ronda Demattei — Assoc. Prof./Dental Hygiene Program · (618) 453-7298
Other names Illinois Children'S Healthcare Foundation Dental Grant Project
NPI enumeratedMarch 27, 2008
Last updated in NPPESMarch 27, 2008
Mailing address1365 Douglas Dr, College Of Applied Sciences/School Of Allied Health, Carbondale, IL 62901-6615

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