| NPI | 1871754440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIDA RADFAR Director 405-348-9911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5905) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 5905) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2008-06-17 |