| NPI | 1407004096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY FITZGERALD Owner 405-360-7716 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 4871) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2008-09-08 |