| NPI | 1013942689 |
|---|---|
| Former Legal Business Name | PRIME TIME DENTAL |
| Entity Type | Organization |
| Authorized Contact | AILEEN L RICHARDSON President 480-421-0113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2020-08-22 |