| NPI | 1154537884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD K SHELLEY Owner Doctor 623-362-9616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 3505) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 4433) |
| 1223G0001X Dentist, General Practice (Licence: AZ 5928) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2012-10-02 |