| NPI | 1447792759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNE JOELLE DEMMY Credentialing Specialist 918-998-0996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2016-11-17 |
| Last Update Date | 2021-10-21 |