| NPI | 1548656457 |
|---|---|
| Other Name | LEGACY SMILES OF SOUTHERN AZ |
| Entity Type | Organization |
| Authorized Contact | DAWNIE KILDO Owner 520-625-0131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D5331) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2019-07-17 |