| NPI | 1154739381 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK R VANDENBERG Owner 405-722-7767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK ok5132) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2014-07-31 |