| NPI | 1972151587 |
|---|---|
| Other Name | LAKECREST OWASSO |
| Entity Type | Organization |
| Authorized Contact | MICHELLE MAYRE MOSS Office Manager 918-376-6165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2019-10-29 |