| NPI | 1235800897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA ZWICKY Credentialing & Enrollment Manager 480-866-8811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2021-12-27 |