| NPI | 1265180400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNA MICHELLE JORDAN Director Of Clinical Operations 918-899-9468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2022-03-16 |
| Last Update Date | 2022-03-16 |