| NPI | 1104553478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REVAN DAWOOD Dentist 623-262-4372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 1223E0200X Dentist, Endodontics | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| 261QS1200X Clinic/Center, Sleep Disorder Diagnostic | |
| Enumeration Date | 2022-08-05 |
| Last Update Date | 2024-06-08 |