| NPI | 1841862265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | UMAR M IMTIAZ Associate Provider 623-444-9999 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-07-14 |