| NPI | 1104931971 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERI WEAVER Office Manager 623-362-1150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ 07-634197-Q) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2020-08-22 |