| NPI | 1962763003 |
|---|---|
| Other Name | 59TH AVENUE DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | MATTHEW REED PARKER Owner 801-602-3985 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008419) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2012-06-05 |