| NPI | 1639353337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES SID DAVIS Owner 928-774-4311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 5223) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2008-06-12 |