| NPI | 1659860393 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN JOHNSON Business Advisor 877-221-7750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 6796) |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2018-05-08 |