| NPI | 1598354615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER RYAN ROYBAL Owner /Dentist 602-315-6380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2021-01-13 |