| NPI | 1497265516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NINO POLLACCIA Owner 623-230-2297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2022-03-24 |