| NPI | 1174810840 |
|---|---|
| Doing Business As | AGE DEFYING DENTISTRY, PHOENIX |
| Entity Type | Organization |
| Authorized Contact | DAVID J VELASCO Co Owner 602-595-1115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ AZ3740) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ AZ4044) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2012-08-02 |