| NPI | 1528333168 |
|---|---|
| Doing Business As | OPEN WIDE DENTAL |
| Entity Type | Organization |
| Authorized Contact | THOMAS DURISEK President 602-347-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2012-03-15 |
| Last Update Date | 2012-03-15 |