| NPI | 1295098689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY DALTON Credentialing Specialist 623-640-0267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2021-06-22 |