| NPI | 1295083202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE CARMELLA MAMOLA Rdh/Owner 602-717-7757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: AZ h04804) |
| 124Q00000X Dental Hygienist (Licence: AZ h05302) | |
| Enumeration Date | 2012-08-22 |
| Last Update Date | 2012-08-24 |