| NPI | 1942078571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE LAUREN HERR Managing Member 480-382-3314 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2023-12-13 |
| Last Update Date | 2024-05-24 |