| NPI | 1063897411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELCIE THOMPSON Billing Manger 928-925-6522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D5634) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D8489) |
| 1223G0001X Dentist, General Practice (Licence: AZ D8753) | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2015-07-28 |