| NPI | 1316140585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE RAE BENNETT Owner 520-886-3303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D4891) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2020-08-22 |