| NPI | 1811642770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAYLON ZISSA Director Of Provider Relations 405-945-8941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2022-02-18 |