| NPI | 1932822350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAYLON ZISSA Director Of Provider Relations 405-945-8941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2022-09-21 |