| NPI | 1093082679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK RORY CHASE President 602-843-0010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 3276) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2011-11-25 |
| Last Update Date | 2011-11-25 |