| NPI | 1831554930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN LAVENE Endodontist 928-854-5551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ 8823) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AZ 8793) |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2015-12-16 |