| NPI | 1831587575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY DUSSAULT Office Manager 405-513-6630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK OK4913) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK OK6256) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2015-01-07 |