| NPI | 1316069891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN COSTELLO President 918-492-3752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5475) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2020-08-22 |