NPI | 1942744081 |
---|---|
Doing Business As | SAN TAN MOUNTAIN DENTAL |
Entity Type | Organization |
Authorized Contact | KENDRA WALKER Credentialing Supervisor 217-540-8312 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2016-12-08 |
Last Update Date | 2017-04-27 |