Healthcare Provider Details

I. General information

NPI: 1619941242
Provider Name (Legal Business Name): BOB H WOMACK D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 STANLY RD
CLAYTON OK
74536
US

IV. Provider business mailing address

PO BOX 219
CLAYTON OK
74536-0219
US

V. Phone/Fax

Practice location:
  • Phone: 918-569-4143
  • Fax:
Mailing address:
  • Phone: 918-917-9999
  • Fax: 918-917-7552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1516
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: