| NPI | 1972097392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAM D BUCKHANAN Insurance Coordinator 480-445-9188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009270) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2018-06-19 |