| NPI | 1104019918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELDON DWAYNE JENKINS Owner 480-205-2476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D5797) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2007-08-24 |