| NPI | 1689886657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL J BLAZIC Owner 623-935-5774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AZ M31657) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |