| NPI | 1225416027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTOFER KELLIS Office Manager 480-888-7711 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D008105) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2015-05-12 |