| NPI | 1104617745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA WEITH Director Of Payor Relations 623-267-8121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2025-05-14 |
| Last Update Date | 2025-05-14 |