| NPI | 1780778951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE D STORTS Owner 580-223-6720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 4633) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 5443) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-08-22 |