| NPI | 1659021673 |
|---|---|
| Doing Business As | PREMIER DENTAL PARTNERS WEST COUNTY - OLD BALLAS ORAL SURGERY |
| Entity Type | Organization |
| Authorized Contact | CELIA HAYES Credentialing Coordinator 217-540-8905 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2023-02-08 |