| NPI | 1801314810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY WHEELER Owner 520-979-1979 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2022-07-21 |