| NPI | 1225274913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDANA KHESHTCHIN Dentist 480-921-3811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AZ D5191) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2008-12-30 |