| NPI | 1164722021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE GEORGE GROOP Director 480-889-9457 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D07819) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D07819) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2013-10-31 |