| NPI | 1255421897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE ROBERT RADDATZ President 602-248-8745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ 1421) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2020-08-22 |