| NPI | 1497576284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRENT WILSEY SMALLWOOD Dentist 480-894-8101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2024-10-23 |
| Last Update Date | 2024-10-28 |