| NPI | 1235514183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA BASSETT Owner/Manager 405-377-7323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2019-03-06 |