| NPI | 1487219580 |
|---|---|
| Doing Business As | 100 WEST DENTAL |
| Entity Type | Organization |
| Authorized Contact | BRANDON PRIOR Owner/Dentist 618-514-2520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2019-05-03 |