| NPI | 1043776644 |
|---|---|
| Doing Business As | GARDEN LAKES FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | TIM J WILDUNG CEO / Treasurer 602-391-4107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-02-19 |
| Last Update Date | 2019-02-19 |