| NPI | 1720656705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIAH THIBAULT Chief Operations Officer 520-276-2220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2021-06-15 |