John A. Logan College

NPI #1598055741 in Carterville, Illinois

Provider Information

NPI Number: 1598055741
Entity Type: Organization
Organization Name: John A. Logan College
Primary Specialty: Dentist
Enumeration Date: Apr 8, 2011
Last Updated: Apr 8, 2011

Practice Location

Address: 700 LOGAN COLLEGE DR
City: Carterville
State: Illinois
ZIP Code: 62918-2500
Phone: (618) 985-2828

Authorized Official

Name: MRS. PAM RUTH KARNS, RDH, MS
Title: DEPARTMENT CHAIR FOR ALLIED HEALTH
Phone: (618) 985-2828

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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