| NPI | 1255946257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA KELLICI Manager 623-439-2280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2024-08-30 |