| NPI | 1912255845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY LYNN WHITE Owner 580-252-9422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 5560) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 44262) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2012-08-27 |