| NPI | 1083141329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESIA CRAWFORD Credentialing Specialist 623-299-8799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D05894) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: AZ D05894) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2023-08-09 |