| NPI | 1568063576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN KYLE SPARKMAN Owner 806-355-9732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2020-11-05 |