| NPI | 1104154624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS AULD Owner 918-423-0200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 4337) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6096) |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2020-04-16 |