MEDICARE: ROBERT W. UTECHT, D.D.S., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	4055	OK

General Provider Information

NPI Number	:	1235270083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT W. UTECHT, D.D.S., INC.

Provider Business Mailing Address
First Line	:	1908 S POST RD
Second Line	:	BLDG. #1
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6600
Country	:	US
Telephone Number	:	405-732-2230
Fax Number	:	405-732-2109

Provider Business Practice Location Address
First Line	:	1908 S POST RD
Second Line	:	BLDG. #1
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6600
Country	:	US
Telephone Number	:	405-732-2230
Fax Number	:	405-732-2109

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT WILLIAM UTECHT
Credential	:	DDS
Telephone Number	:	405-732-2230

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	11/24/2009

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