| NPI | 1376713362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT N MARTINEAU President/Owner 623-975-3933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ D6112) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2018-11-09 |