| NPI | 1790108900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAYLON ZISSA Director 405-945-8941 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 6025) |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2024-01-11 |