Robert London, DDS

Key facts

NPI

1801070255

Entity type

Individual (NPI type 1)

Primary specialty

Dentist 122300000X

License

3854 (OK)

Practice address

1520 S Main St
Blackwell, OK 74631-4921

Phone

(580) 628-7741

NPI assigned

Dec 20, 2007

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 20, 2007.

{
    "created_epoch": "1198108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198108800000",
    "number": "1801070255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 S MAIN ST",
            "city": "BLACKWELL",
            "state": "OK",
            "postal_code": "746314921",
            "telephone_number": "580-628-7741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 S MAIN ST",
            "city": "BLACKWELL",
            "state": "OK",
            "postal_code": "746314921",
            "telephone_number": "580-628-7741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONDON",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-20",
        "last_updated": "2007-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "3854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF DENTISTRY",
            "identifier": "3854",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Blackwell, OK · Dentist in Oklahoma