| NPI | 1245432533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYSORE SURESH President 480-491-0404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 3857) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-08-22 |