| NPI | 1740654847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAELANNE CHADWICK Receptionist 520-575-5576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 6203) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 9026) |
| Enumeration Date | 2015-11-30 |
| Last Update Date | 2015-11-30 |