| NPI | 1235256009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL RAYMOND ROBERTSON President 928-634-5033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: AZ 4515) |
| Enumeration Date | 2007-03-25 |
| Last Update Date | 2020-08-22 |