| NPI | 1134279102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEJ DATTATRAYA LAD Doctor 918-369-6118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5667) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2019-10-21 |