Provider Demographics
NPI:1871504191
Name:REVILLE, WILLIAM P (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:REVILLE
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 1:3804 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73122-2016
Mailing Address - Country:US
Mailing Address - Phone:405-789-5552
Mailing Address - Fax:405-789-8201
Practice Address - Street 1:3804 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73122-2016
Practice Address - Country:US
Practice Address - Phone:405-789-5552
Practice Address - Fax:405-789-8201
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK44261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice