| NPI | 1962798595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS BLAKE SUDBERRY Dentiist 580-226-1515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5443) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2011-06-22 |