| NPI | 1225202138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT W. MOODY President 405-755-8020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 5120) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2008-04-22 |