| NPI | 1104130418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES ALAN WEAVER Member 520-745-0654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2010-07-28 |