| NPI | 1528204591 |
|---|---|
| Doing Business As | 75TH AVENUE DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | FAWNE E PRYOR Insurance Manager 623-582-3902 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D6772) |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2008-12-22 |