| NPI | 1003082132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY ANNE NINNESS Executive Director 405-236-0413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 2302) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 4480) |
| 1223G0001X Dentist, General Practice (Licence: OK 3065) | |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2008-05-08 |