| NPI | 1326104464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY D. BLACKBURNE President 405-329-6106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OK 3554) |
| Enumeration Date | 2006-12-30 |
| Last Update Date | 2020-08-22 |