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General NPI Number Information
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NPI Number | 1568567493
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Entity Type | Individual
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Provider Name | BOBBY DON CHEATHAM DDS
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2800 NORTH KELLY AVENUE 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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Provider Business Mailing Address
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Address Line | 4205 CHERRY HILL LANE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-8105
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Country | US
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Telephone | 405-755-9837
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Fax | 405-752-2091
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 422062SPECIALTY
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License Number State | OK
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