| NPI | 1639552359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER HOLT Gra 405-271-4148 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 6591) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2015-06-30 |