| NPI | 1962523100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA R NICHOLS Office Manager 405-271-4441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-08-22 |