| NPI | 1356885073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN GLEN MITCHELL Dentist 520-881-6767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: AZ 7359) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2017-02-22 |