| NPI | 1942807144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CREED CARDON Owner 918-998-0996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2020-10-01 |