| NPI | 1487651071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORIN DEAN PETERSON President 928-773-2530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: AZ 2803) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2007-10-16 |