| NPI | 1831601657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATISHA BOOTH Office Manager 580-279-5760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 4245) |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2017-11-02 |