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Organization
CICERO FAMILY DENTAL LLC
Active
Organization
CICERO FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BLAKE WESTRA DMD (OWNER)
(217) 549-6928
Entity
Organization
Contact information
Practice address
411 N PERU ST, CICERO, IN 46034-9498
(317) 984-3531
Mailing address
522 E JASPER ST, PARIS, IL 61944-2437
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
08/24/2017
Last updated
07/31/2024
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