Southern Illinois University Edwardsville School of Dental Medicine

NPI #1215912696 in Alton, Illinois

Provider Information

NPI Number: 1215912696
Entity Type: Organization
Organization Name: Southern Illinois University Edwardsville School of Dental Medicine
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 8, 2005
Last Updated: Jul 10, 2007

Practice Location

Address: 2800 COLLEGE AVE
City: Alton
State: Illinois
ZIP Code: 62002-4700
Phone: (618) 474-7080

Authorized Official

Name: DR. DEBRA M SCHWENK, DMD
Title: ASSOCIATE DEAN FOR CLINICAL AFFAIRS
Phone: (618) 474-7080

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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