| NPI | 1295919751 |
|---|---|
| Doing Business As | OPEN WIDE DENTAL |
| Entity Type | Organization |
| Authorized Contact | THOMAS SCOTT DURISEK President 602-347-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AZ 4777) |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2007-12-19 |