| NPI | 1043685357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD GEORGE DERIANA Member/Dentist 520-742-2167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: AZ DO3161) |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2015-12-11 |