| NPI | 1194294652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE KING Credentialing Manager 480-607-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2020-07-27 |