| NPI | 1780966036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLINTON BLAKE Dentist/Owner 405-392-4883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 6330) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2011-09-13 |