Individual
DR. RICHARD TODD BOONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
803 N MONTE VISTA ST, ADA, OK 74820-7711
(580) 332-3010
(580) 332-1302
Mailing address
803 N MONTE VISTA ST, ADA, OK 74820-7711
(580) 332-3010
(580) 332-1302
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4808
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100112550A
—
OK
01
—
787600
UNITED CONCORDIA
OK
Enumeration date
08/30/2005
Last updated
08/07/2013
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