| NPI | 1518578095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CREED L CARDON Clinical Director 918-998-0996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2020-09-29 |