| NPI | 1174707772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY WILLIAM MANGELSDORF Dentist 928-718-2136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: AZ 3751) |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2007-12-19 |