| NPI | 1568517597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE DALE DITTERLINE Owner 928-634-7585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D4395) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-08-22 |