| NPI | 1295090678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY R MANNING Owner Provider 480-988-2373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: AZ 7453) |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2025-09-08 |