| NPI | 1174859870 |
|---|---|
| Doing Business As | SHAWNEE HEALTH CARE, CARBONDALE DENTAL |
| Entity Type | Organization |
| Authorized Contact | CHRISTINA CARNEY CEO 618-956-9521 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 124Q00000X Dental Hygienist | |
| 126800000X Dental Assistant | |
| Enumeration Date | 2009-10-30 |
| Last Update Date | 2024-04-04 |