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 |