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General NPI Number Information
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NPI Number | 1205002243
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Entity Type | Organization
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Legal Business Name | RICK L. WILLINGHAM, D.D.S., P.C.
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 1700 PROFESSIONAL CIR
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City | YUKON
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State | OK
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Zip | 73099-6470
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Country | US
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Telephone | 405-354-4893
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Fax | 405-350-3283
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Provider Business Mailing Address
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Address Line | 1700 PROFESSIONAL CIR
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City | YUKON
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State | OK
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Zip | 73099-6470
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Country | US
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Telephone | 405-354-4893
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Fax | 405-350-3283
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | RICK L. WILLINGHAM
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Credential | D.D.S.
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Telephone | 405-354-4893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5038
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License Number State | OK
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