| NPI | 1851424287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LETISHA J. HAWTHORNE Office Manger 623-931-9221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 1926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 4315) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-08-22 |