| NPI | 1497247431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEIANN FISH Office Manager 928-537-4363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AZ AZ5444) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2018-06-05 |