| NPI | 1750660700 |
|---|---|
| Former Legal Business Name | HENRYETTA DENTAL CENTER, PLLC |
| Entity Type | Organization |
| Authorized Contact | JEREMY SCOTT JOHNSON Dentist 9818-652-2555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: OK 5868) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2011-08-09 |