| NPI | 1881281889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY TRAN Manager 480-477-3090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 122300000X Dentist |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2020-12-23 |
| Last Update Date | 2020-12-28 |