| NPI | 1306035654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY JOHN LAGERS President 602-996-1660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: AZ 2390) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2007-10-22 |