| NPI | 1457448698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAVEL LOU WELLS CEO/President 580-248-8418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 1073) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 3494) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 4781) | |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2020-08-22 |