| NPI | 1831273002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAM NIRUYI President 602-320-0246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 56796) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ d5292) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2011-05-08 |