| NPI | 1386121473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA DALE MATHIS Owner Dentist 918-852-4854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: AL 6400) |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2018-07-23 |