| NPI | 1891184297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESE GARVEY Owner 602-992-1486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 1223X2210X Dentist Orofacial Pain | |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2024-08-01 |