| NPI | 1144355470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGIE D DERRICK Office Manager 520-572-1593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D4718) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2010-08-24 |