| NPI | 1194299941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE HALL Business Manager 623-910-5569 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2019-01-15 |