| NPI | 1295948883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL KEITH LOUT President 480-396-3660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D3911) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-22 |