| NPI | 1285432518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYNE JACKSON Owner 480-353-6476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2025-03-04 |
| Last Update Date | 2025-03-04 |