| NPI | 1386917839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EOIN KIRBY Credentialing Supervisor 602-370-1511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D5063) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D5110) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D1819) | |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2012-02-29 |