NPI | 1073204012 |
---|---|
Entity Type | Organization |
Authorized Contact | GAYLON ZISSA Director Of Provider Relations 405-945-8941 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2023-05-19 |
Last Update Date | 2023-05-19 |