| NPI | 1376646935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD LELAND SPARKS Owner/President 602-993-8800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ 1510) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2020-08-22 |