| NPI | 1952617482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER HEARNE Regional Director 520-227-0711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24363) |
| Enumeration Date | 2010-08-21 |
| Last Update Date | 2010-08-21 |