| NPI | 1669647996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE BOLIO Insurance Coordinator/Receptionist 623-209-0012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D6611) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2008-04-28 |