| NPI | 1831613934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN M ISRAELSEN Owner/Manager/Dentist 520-458-2415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008200) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2022-07-21 |