| NPI | 1861551210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL S. CROCKETT President 480-981-0203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D6584) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2020-08-22 |