| NPI | 1669694642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY LUCAS R President 580-256-6054 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OK 3239) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |