| NPI | 1093266363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK PALMER Owner 928-428-6161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 8425) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ 8425) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ 8425) | |
| 124Q00000X Dental Hygienist (Licence: AZ 8425) | |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2016-10-20 |