Provider Demographics
NPI:1548273972
Name:ROUBIK, GEOFFREY (DDS)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:
Last Name:ROUBIK
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 1:3333 NW 63RD ST
Mailing Address - Street 2:SUITE:200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3710
Mailing Address - Country:US
Mailing Address - Phone:405-848-6641
Mailing Address - Fax:405-858-8663
Practice Address - Street 1:3333 NW 63RD ST
Practice Address - Street 2:SUITE:200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3710
Practice Address - Country:US
Practice Address - Phone:405-848-6641
Practice Address - Fax:405-858-8663
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist