| NPI | 1407882681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE LYNN PRATT Central Office Manager 602-995-7336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ 2428) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2020-08-22 |