| NPI | 1639622103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOAN L FOX Dentis 480-226-5652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: AZ D4274) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: NM DD4407) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2016-10-20 |