| NPI | 1932294741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT ROBERT JACKSON President 623-933-0550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 2532) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |