| NPI | 1790139913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE BURTON BUSHMAN Owner 928-348-8884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 4783) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2016-04-14 |