Provider Demographics
NPI:1518265925
Name:A. GEOFFREY ROUBIK DDS PC
Entity Type:Organization
Organization Name:A. GEOFFREY ROUBIK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROUBIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-848-6641
Mailing Address - Street 1:3333 NW 63RD ST
Mailing Address - Street 2:SUITE:200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3722
Mailing Address - Country:US
Mailing Address - Phone:405-848-6641
Mailing Address - Fax:405-858-8663
Practice Address - Street 1:3333 NW 63RD ST
Practice Address - Street 2:SUITE:200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3722
Practice Address - Country:US
Practice Address - Phone:405-848-6641
Practice Address - Fax:405-858-8663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty