| NPI | 1063649192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY SUE MCKINNEY Office Manager 480-218-7590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ 2619) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: AZ 7751) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2009-06-16 |