| NPI | 1508219544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW E FORMAN Orthodontist 480-348-5547 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: AZ 1625) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2017-01-13 |