| NPI | 1366315319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA WIETH Director Of Payor Relations 623-267-8121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2025-09-25 |
| Last Update Date | 2025-09-25 |