| NPI | 1013023928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES G BODE Oral Surgeon 602-938-0880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ 5950) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ 2579) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-08-22 |