| NPI | 1487590428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA WIETH Director, Payor Relations 623-267-8121 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2026-04-23 |
| Last Update Date | 2026-04-23 |