| NPI | 1437438579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL SIMMONDS CANNON Owner 918-743-1351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 158) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2011-08-08 |