Provider Demographics
NPI:1710910534
Name:WOMBLE, DAVID ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:WOMBLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:WOMBLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:7101 NW EXPRESSWAY ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-1578
Mailing Address - Country:US
Mailing Address - Phone:405-722-7042
Mailing Address - Fax:405-773-0443
Practice Address - Street 1:7101 NW EXPRESSWAY ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-1578
Practice Address - Country:US
Practice Address - Phone:405-722-7042
Practice Address - Fax:405-773-0443
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice