| NPI | 1255507224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY EDWARD MOORE President 918-494-7676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OK 3981) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2008-04-30 |