| NPI | 1871018887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIELA DOMINGUEZ Managing Member 480-669-6419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D9064) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: AZ D06147) |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2022-07-21 |