| NPI | 1114287091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN ROBERTS Owner/Member 918-970-4944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2023-08-14 |