| NPI | 1740702158 |
|---|---|
| Doing Business As | DENTAL CARE AT WESTSIDE SHOPPES |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing Supervisor 217-540-8312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2022-07-21 |