| NPI | 1972235992 |
|---|---|
| Doing Business As | YOUR OLATHE DENTIST |
| Entity Type | Organization |
| Authorized Contact | REBECCA CONDLEY Credentialing Specialist 918-960-3070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2022-06-28 |