| NPI | 1821381286 |
|---|---|
| Doing Business As | PICACHO FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | JASON THOMAS LEMMON Dentist/Owner 928-344-3177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ AZ7490) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX TX23451) |
| 122300000X Dentist (Licence: CA CA59150) | |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2011-05-18 |