| NPI | 1962865949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBBY LONG Director Of Business Operations 405-376-6565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2016-03-29 |