| NPI | 1164639100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD R BLACKWELL Dentist Owner 480-726-8464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AZ 5291) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-08-22 |