Provider Demographics
NPI:1134290562
Name:ROBERT M DEW D D S INC
Entity Type:Organization
Organization Name:ROBERT M DEW D D S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-689-7788
Mailing Address - Street 1:105 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432
Mailing Address - Country:US
Mailing Address - Phone:918-689-7788
Mailing Address - Fax:918-689-7789
Practice Address - Street 1:105 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432
Practice Address - Country:US
Practice Address - Phone:918-689-7788
Practice Address - Fax:918-689-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty