Provider Demographics
NPI:1376574046
Name:CARMEN, BOBBY JOSEPH (DDS)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:JOSEPH
Last Name:CARMEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 SONOMA PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071
Mailing Address - Country:US
Mailing Address - Phone:405-364-2200
Mailing Address - Fax:405-364-8780
Practice Address - Street 1:1141 SONOMA PARK DRIVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071
Practice Address - Country:US
Practice Address - Phone:405-364-2200
Practice Address - Fax:405-364-8780
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist