Provider Demographics
NPI:1205002243
Name:RICK L. WILLINGHAM, D.D.S., P.C.
Entity Type:Organization
Organization Name:RICK L. WILLINGHAM, D.D.S., P.C.
Other - Org Name:WILLINGHAM & REITER, D.D.S.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-354-4893
Mailing Address - Street 1:1700 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6470
Mailing Address - Country:US
Mailing Address - Phone:405-354-4893
Mailing Address - Fax:405-350-3283
Practice Address - Street 1:1700 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6470
Practice Address - Country:US
Practice Address - Phone:405-354-4893
Practice Address - Fax:405-350-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1407848765OtherTYPE 1 NPI
OK1366434649OtherTYPE 1 NPI
OK884113OtherUNITED CONCORDIA INSURANCE