| NPI | 1477075653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LUCAS Office Manager 480-945-0663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AZ 12096) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2017-12-29 |