Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 3814 | OK |
NPI | 1063561868 |
---|---|
Provider Name | Dr. Donald Hall Roberts JR. |
First Address | Norman, OK 73069-6365 |
Second Address | Norman, OK 73069-6365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |