| NPI | 1992415566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IHNBAE CHO Dds 520-906-5765 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2023-02-09 |