| NPI | 1053969568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHASSITY NICOLE GOMEZ Ins COO Rdinator 480-589-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2019-08-28 |