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 |