| NPI | 1154627404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAN ALLEN Manager 520-777-6001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D6558) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2011-02-03 |
| Last Update Date | 2023-01-23 |