| NPI | 1942804703 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAYRA VALENZUELA Billing Manager 602-820-0288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality |
| Enumeration Date | 2020-11-23 |
| Last Update Date | 2020-11-23 |