| NPI | 1265735724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERA ANN WELLNER Credentialing Rep 405-848-7974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OK 160) |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2013-11-13 |