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General NPI Number Information
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NPI Number | 1275057887
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Entity Type | Organization
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Legal Business Name | BOBBY D. CHEATHAM,D.D.S.,PC
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Dates
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Enumeration Date | 07/26/2017
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Last Update Date | 07/26/2017
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Provider Practice Location Address
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Address Line | 2800 N KELLY AVE STE 200
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City | EDMOND
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State | OK
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Zip | 73003-3004
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Country | US
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Telephone | 405-562-2222
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Fax | 405-562-2222
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Provider Business Mailing Address
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Address Line | 2800 N KELLY AVE STE 200
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City | EDMOND
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State | OK
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Zip | 73003-3004
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Country | US
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Telephone | 405-562-2222
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Fax | 405-562-2200
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DR. BOBBY DON CHEATHAM
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Credential | DDS
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Telephone | 405-562-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 4220
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License Number State | OK
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