| NPI | 1225692213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA ZWICKY Credentialing Manager 480-866-8811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2024-11-01 |