| NPI | 1144494147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENALLA KAYE ELLIS Owner 405-273-2002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5285) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2008-04-22 |