| NPI | 1679469050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSIE WIETH Director Of Payor Relations 623-267-8121 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2025-06-13 |
| Last Update Date | 2025-06-13 |