| NPI | 1124989421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMAL WELLS CEO 928-202-0181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2025-11-18 |
| Last Update Date | 2025-11-18 |