| NPI | 1609475060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LY Owner 480-900-7838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2020-10-18 |
| Last Update Date | 2020-12-10 |