| NPI | 1982997441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE DAVID LAIZURE Production Manager 623-388-4932 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2011-05-17 |