| NPI | 1720565294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAM BUCKHANAN Coordinator 480-899-7996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AZ D009270) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2018-07-26 |