# CICERO FAMILY DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912424672
- **Authorized official:** BLAKE WESTRA DMD (OWNER)
- **Authorized official phone:** (217) 549-6928

## Contact information

- **Practice address:** 411 N PERU ST, CICERO, IN 46034-9498
- **Practice address phone:** (317) 984-3531
- **Mailing address:** 522 E JASPER ST, PARIS, IL 61944-2437

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |
| 332BC3200X | Customized Equipment (DME) | — | — | — |

## Other

- **Enumeration date:** 08/24/2017
- **Last updated:** 07/31/2024