NPIMap

Organization Active NPI

Shawnee Health Service and Development Corp

Doing business as Shawnee Health, Children's Dental Center - Advanced Care

  • Pediatric Dentistry
  • Marion, IL
National Provider Identifier
1164385753
Registry record updated Dec 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Doing business as
Shawnee Health, Children's Dental Center - Advanced Care
Practice address
3115 Williamson County Pkwy Ste B
Marion, IL 62959-5287
Phone
(618) 519-9200
NPI assigned
Dec 9, 2025
Last updated
Dec 9, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christina Carney
Title
Ceo
Phone
(618) 985-8221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

3115 Williamson County Pkwy Ste B
Marion, IL 62959-5287

Mailing address

109 California St
Carterville, IL 62918-1923
Phone (618) 519-9200

Other names 1

  • Shawnee Health, Children's Dental Center - Advanced Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Grand Tower Comm HLTH C37 organizations share this tax ID, including this one
Part of
Grand Tower Comm HLTH C

Other organizations with this tax ID 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

Locations

3115 Williamson County Pkwy
Ste B
Marion, IL 62959

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1765238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765238400000",
    "number": "1164385753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CALIFORNIA ST",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629181923",
            "telephone_number": "618-519-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3115 WILLIAMSON COUNTY PKWY STE B",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595287",
            "telephone_number": "618-519-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP",
        "enumeration_date": "2025-12-09",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A",
        "authorized_official_last_name": "CARNEY",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-985-8221"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shawnee Health, Children's Dental Center - Advanced Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.