| NPI | 1720228075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM BERNARD WYNN President 918-492-0737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: OK 5447) |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2009-02-26 |