NPI | 1861879066 |
---|---|
Doing Business As | SURPRISE DENTAL |
Entity Type | Organization |
Authorized Contact | KRYSTAL POWELL Revenue Cycle Director 623-583-3001 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: AZ 1014823) |
Enumeration Date | 2015-04-27 |
Last Update Date | 2023-04-28 |