=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649391509
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD KEITH BILLMAN DDS, MS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 12/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 608 NW 138TH ST
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-1963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-924-0035
-----------------------------------------------------
Fax | 405-672-6512
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13919B N MAY AVE # 174
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73134-5035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-924-0035
-----------------------------------------------------
Fax | 405-242-3014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 4962
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------