| NPI | 1689946964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY MCNICKLE Owner 405-624-3880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 3939) |
| 122300000X Dentist (Licence: OK 5802) | |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2023-03-08 |