| NPI | 1619130465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER A BASSETT Owner 623-435-2300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: AZ 2176) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2008-07-02 |