| NPI | 1932579448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY DALTON Credentialing Specialist 623-640-0267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008070) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2019-09-03 |