| NPI | 1528250693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT CLARK Doctor 480-994-9485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AZ 6575) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: AZ 5498) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2007-08-13 |