| NPI | 1598433278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW BRADLEY HALL Owner 918-523-4999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2021-08-30 |