| NPI | 1457533523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HALEY WOOSTER Enrollment Specialist 712-733-8551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 3749) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2023-11-06 |