| NPI | 1851094528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBBY YASSO Dentist 602-613-8004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2023-04-11 |