| NPI | 1942489372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROY SONG Dentist 623-849-1356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D6192) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D6294) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2007-11-02 |