| NPI | 1487539037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIAH THIBAULT Chief Operations Officer 520-276-2220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2025-08-11 |