Provider Demographics
NPI:1831272905
Name:ROBERT P LONDON DDS CORP
Entity type:Organization
Organization Name:ROBERT P LONDON DDS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-363-0728
Mailing Address - Street 1:1520 S MAIN
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-4921
Mailing Address - Country:US
Mailing Address - Phone:580-363-0728
Mailing Address - Fax:580-363-1574
Practice Address - Street 1:1520 S MAIN
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-4921
Practice Address - Country:US
Practice Address - Phone:580-363-0728
Practice Address - Fax:580-363-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty