| NPI | 1700356292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUISANA MEDINA Administrative Assistant Credential 928-819-8834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2024-08-12 |