| NPI | 1881991032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA MATLI SCOVILLE Owner 580-623-7121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 4530) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2016-08-29 |