| NPI | 1225620883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENA MOORHEAD Owner 480-586-6101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2021-11-05 |