| NPI | 1669519559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J WALLACE Dentist 405-340-0411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5801) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-08-22 |