| NPI | 1033759584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORY QUIETT Credentialing Specialist 918-297-8951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2021-05-14 |