| NPI | 1316126683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONAH VANDIVER President 918-492-1917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OK 5392) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2007-11-02 |