| NPI | 1669012241 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATHEW PETERSEN Owner 480-233-6944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2020-02-18 |