| NPI | 1861798829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA ZWICKY Credentialing Manager 480-866-8811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 25043) |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2023-08-22 |