| NPI | 1629708417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CREED CARDON Owner 918-998-0996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2023-11-08 |