| NPI | 1346781960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MENDY JENNERMAN Office Manager 405-321-2300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 4167) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6632) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2017-03-15 |