| NPI | 1285373860 |
|---|---|
| Doing Business As | MUDDY BRANCH DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | COURTNEY MONTEITH Credentialing Coordinator 217-540-8306 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2022-06-01 |