| NPI | 1952572091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY MICHAEL SHANNON Owner/Orthodontist 405-321-2735 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 136) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 166) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2008-03-17 |