| NPI | 1154623239 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN BADER Doctor 480-661-1818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ 5242) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: AZ 6260) |
| Enumeration Date | 2010-11-23 |
| Last Update Date | 2014-12-04 |