| NPI | 1205046828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM J BLUM Owner 405-360-5566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 4455) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2019-06-06 |