| NPI | 1144301995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDOLPH A SNYDER Periodontist 928-343-0098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ 3124) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2009-11-19 |