| NPI | 1730389669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY JUSTIN REAVIS Dentist 918-369-3990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 4843) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2008-06-23 |