| NPI | 1518755578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSIE WIETH Director Of Payor Relations 623-267-8121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2025-04-29 |
| Last Update Date | 2025-04-29 |