| NPI | 1396772950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL A PROST Dentist 623-825-7833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 4974) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12010098A) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2020-08-22 |