| NPI | 1225505134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGET SHIELDS Credentialing Manager 480-406-8677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2018-10-29 |