| NPI | 1114189883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW MARVIN PETERSEN Owner 480-893-7733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 7013) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2008-06-25 |