| NPI | 1033484720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON WAYNE LOWRY Owner 928-753-5069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 6171) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2012-06-04 |