| NPI | 1245038579 |
|---|---|
| Doing Business As | DENTAL CARE AT PROVIDENCE |
| Entity Type | Organization |
| Authorized Contact | CEMYIRA MCDOUGAL Credentialing Coordinator 217-764-8609 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2025-03-04 |
| Last Update Date | 2025-03-04 |