| NPI | 1740465244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN F OLSEN Manager 480-491-9911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ 7230) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ 7390) |
| 1223G0001X Dentist General Practice (Licence: AZ 7393) | |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2008-01-02 |