Individual
DR. ROBERT LONDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1520 S MAIN ST, BLACKWELL, OK 74631-4921
(580) 628-7741
Mailing address
1520 S MAIN ST, BLACKWELL, OK 74631-4921
(580) 628-7741
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3854
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3854
BOARD OF DENTISTRY
OK
Enumeration date
12/20/2007
Last updated
12/20/2007
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