| NPI | 1154529006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY CLINE DERICKSON Owner 520-327-5993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AZ 2369) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2012-07-26 |