MEDICARE: RANDY WALKER ATKINSON D.D.S.

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	1223G0001X	General Practice Dentistry	4094	OK

General Provider Information

NPI Number	:	1548209117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY WALKER ATKINSON D.D.S.

Provider Business Mailing Address
First Line	:	531 NW 38TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7032
Country	:	US
Telephone Number	:	405-607-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 NW 42ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-6807
Country	:	US
Telephone Number	:	405-525-3000
Fax Number	:	405-525-3977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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