| NPI | 1083815377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLINTON WADE EMERSON Manager 918-459-0092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: OK ORTHO SPECIALTY #153) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2019-12-11 |