| NPI | 1750861233 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN BALLEW President 520-762-3236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AZ d7579) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2018-08-15 |