| NPI | 1649459926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH GRANT JOHANSEN Oral Maxillofacial Surgeon 480-632-1508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: AZ AZ3185) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2007-11-02 |