Provider Demographics
NPI:1215940085
Name:LIVINGSTON, ROBERT J (DDS ORAL AND MAXILLO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:DDS ORAL AND MAXILLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 S YORK
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403
Mailing Address - Country:US
Mailing Address - Phone:918-687-5462
Mailing Address - Fax:918-687-4848
Practice Address - Street 1:1331 S YORK
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403
Practice Address - Country:US
Practice Address - Phone:918-687-5462
Practice Address - Fax:918-687-4848
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T75271Medicare UPIN