| NPI | 1811227002 |
|---|---|
| Doing Business As | COUNTRY CLUB SMILES |
| Entity Type | Organization |
| Authorized Contact | KIMBERLY A. MACK Owner 480-231-7020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2010-01-11 |
| Last Update Date | 2010-01-11 |