Provider Demographics
NPI:1568567493
Name:CHEATHAM, BOBBY DON (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:DON
Last Name:CHEATHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4205 CHERRY HILL LANE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8105
Mailing Address - Country:US
Mailing Address - Phone:405-755-9837
Mailing Address - Fax:405-752-2091
Practice Address - Street 1:2800 NORTH KELLY AVENUE
Practice Address - Street 2:200
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-3004
Practice Address - Country:US
Practice Address - Phone:405-562-2222
Practice Address - Fax:405-562-2200
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK422062SPECIALTY1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100123080AMedicaid
OK100123080DMedicaid