| NPI | 1043827314 |
|---|---|
| Doing Business As | WEDGEWOOD SQUARE DENTAL |
| Entity Type | Organization |
| Authorized Contact | JESSICA BRITT Credentialing Coordinator 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2021-01-15 |