| NPI | 1780858654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY MICHAEL WYATT President/Dentist 405-842-0033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: OK 4910) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2008-04-22 |