| NPI | 1104049089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE D SEAMAN Partner 928-774-1481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 2792) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 5855) |
| 122300000X Dentist (Licence: AZ 5906) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2020-08-22 |