| NPI | 1194236125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAIL E GARRISON Credentialing Manager 623-282-9959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2017-10-17 |