| NPI | 1740577360 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC STAVOE Owner 602-843-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 3421) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 3360) |
| Enumeration Date | 2011-07-03 |
| Last Update Date | 2011-07-03 |