| NPI | 1699013201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN RYAN PETERSON Owner 480-899-6407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AZ D7899) |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2013-01-17 |