Provider Demographics
NPI:1407848765
Name:WILLINGHAM, RICK L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:L
Last Name:WILLINGHAM
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 1:211 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2670
Mailing Address - Country:US
Mailing Address - Phone:405-354-4893
Mailing Address - Fax:405-350-3283
Practice Address - Street 1:211 S 4TH ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2670
Practice Address - Country:US
Practice Address - Phone:405-354-4893
Practice Address - Fax:405-350-3283
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist