| NPI | 1881189199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONOVAN R. HANSEN Owner 480-539-6420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AZ D08601) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2018-06-28 |