| NPI | 1518612068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYASANKER VALIYAPARAMBIL Owner/Dentist 623-594-2057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist |
| 261QD0000X Clinic/Center, Dental | |
| 292200000X Dental Laboratory | |
| Enumeration Date | 2022-02-14 |
| Last Update Date | 2022-02-14 |