| NPI | 1205906187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY POULOS Office Manager 480-614-1122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 3469) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 3607) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2020-08-22 |