| NPI | 1427102839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK LARSON Partner 928-758-5588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 4806) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 4026) |
| 1223G0001X Dentist, General Practice (Licence: AZ 4021) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-08-22 |