| NPI | 1831217132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL A. LINES President 480-968-3848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ az1556 and az2288) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-08-22 |