| NPI | 1861762569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA A RABAGO Front Office 520-326-2420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ 1906/G2756) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2012-01-11 |