| NPI | 1215281688 |
|---|---|
| Doing Business As | FIESTA KIDTASTICS |
| Entity Type | Organization |
| Authorized Contact | JAIME JOHNSON Controller 480-648-4037 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2013-12-06 |