| NPI | 1821981010 |
|---|---|
| Doing Business As | DENTAL CARE AT WESTPORT |
| Entity Type | Organization |
| Authorized Contact | JULI RENEE MIETZNER Credentialing Manager 217-540-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2025-05-29 |
| Last Update Date | 2025-05-29 |