| NPI | 1649391293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY SCOTT CULLIMORE Treasurer 480-782-8111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 4668) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-08-22 |