| NPI | 1881181535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY BURNS Head Provider 623-584-9844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D4927) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2018-04-18 |