| NPI | 1922457746 |
|---|---|
| Doing Business As | HALL OF FAME DENTAL |
| Entity Type | Organization |
| Authorized Contact | KELCIE DEE THOMPSON Billing/Insurance Manager 928-925-6522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 6359) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2016-06-13 |