| NPI | 1255136941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA WIETH Payor Relations Manager 623-267-8121 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2025-02-17 |
| Last Update Date | 2025-02-17 |