| NPI | 1013192913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SPENCER G WILSON President 480-279-5949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D0020739) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2008-01-09 |