| NPI | 1184714156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE I. TRACE BRIDGES Owner 580-536-7507 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5215) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2020-08-22 |