| NPI | 1396095816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA ZWICKY Credentialing Manager 480-866-8811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ D04964) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2025-08-20 |