| NPI | 1558433524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH BRETT MANGUM President 928-778-4110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D5563) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2020-08-22 |