| NPI | 1013201052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY BENNETT Owner 918-582-8651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 3828) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2011-07-26 |