| NPI | 1205351392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAIL E GARRISON Credentialing Manager 623-282-9959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2017-08-10 |