| NPI | 1700056355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONAH R.B. VANDIVER Owner/Dentist 918-341-6900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5392) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2008-04-16 |