| NPI | 1992037857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC A PETTERSEN Member 928-567-5249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D3089) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2010-02-03 |