| NPI | 1861032005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI JIMENEZ Financial Coordinator 480-941-5005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2020-01-15 |