| NPI | 1295163418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT RYAN LEE Owner 480-838-4185 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 7570) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 8303) |
| Enumeration Date | 2013-10-25 |
| Last Update Date | 2013-10-25 |