| NPI | 1710216981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH DALE COULSON Dentist 405-354-1861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OK 4351) |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2009-12-16 |