| NPI | 1073960928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KURT D WALLIN Owner/Dentist 623-848-1901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ D008400) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2016-05-20 |