| NPI | 1174533210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEE JO HOLMAN Dentist Owner Sec Treasurer 620-792-1941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 5951) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2020-08-22 |