| NPI | 1154540367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARRON KEENE Office Supervisor 480-610-6544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 5678) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ 5589) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2020-08-22 |