| NPI | 1881063782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT MACK BARNEY Owner 520-663-0419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: AZ 5038) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 5038) |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2021-11-02 |