| NPI | 1912748260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAYLON ZISSA Director Of Provider Relations 405-945-8941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2024-06-03 |