Provider Demographics
NPI:1871601047
Name:ROBY, JOHNNY GORDON JR (DDS)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:GORDON
Last Name:ROBY
Suffix:JR
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 1:4301 NW 63RD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1549
Mailing Address - Country:US
Mailing Address - Phone:405-879-0000
Mailing Address - Fax:405-879-0656
Practice Address - Street 1:4301 NW 63RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1549
Practice Address - Country:US
Practice Address - Phone:405-879-0000
Practice Address - Fax:405-879-0656
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist