| NPI | 1861993040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE DEHERRERA Manager 480-938-0665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D009562) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2024-05-13 |