| NPI | 1124641576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORBIN COWAN CEO 405-229-4052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 122300000X Dentist |
| 1223D0004X Dentist Dentist Anesthesiologist | |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2020-05-20 |