Healthcare Provider Details

I. General information

NPI: 1972597276
Provider Name (Legal Business Name): ROBERT PAUL WEBB III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E DOWNING ST
TAHLEQUAH OK
74464-3016
US

IV. Provider business mailing address

400 E DOWNING ST
TAHLEQUAH OK
74464-3016
US

V. Phone/Fax

Practice location:
  • Phone: 918-456-4477
  • Fax: 918-456-7927
Mailing address:
  • Phone: 918-456-4477
  • Fax: 918-456-7927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4147
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier186197
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerDELTA INS
# 2
Identifier731417460001
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerBCBS INS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: