| NPI | 1366527632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEROME JOHN RIDDLE Dentist 480-991-4410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 4217) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2020-08-22 |