| NPI | 1255561791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEISHA VON EVERETT Owner 405-376-6565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5108) |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2009-07-17 |