| NPI | 1023481553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK PALMER Dentist/Owner 928-428-6161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AZ 8425) |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2015-11-05 |