| NPI | 1538558507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI L TRACY Office Manager 918-682-5518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OK 5961) |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2015-01-14 |