Healthcare Provider Details

I. General information

NPI: 1568976041
Provider Name (Legal Business Name): RC RHOADS DENTAL, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 W 121ST ST STE 101
OVERLAND PARK KS
66209-2028
US

IV. Provider business mailing address

6700 W 121ST ST STE 101
OVERLAND PARK KS
66209-2028
US

V. Phone/Fax

Practice location:
  • Phone: 913-451-2540
  • Fax:
Mailing address:
  • Phone: 913-451-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number61157
License Number StateKS

VIII. Authorized Official

Name: DR. RICHARD DEAN RHOADS JR.
Title or Position: DENTIST
Credential: DDS
Phone: 308-293-1061