Healthcare Provider Details

I. General information

NPI: 1457765208
Provider Name (Legal Business Name): RBMWC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N DOUGLAS BLVD STE T
MIDWEST CITY OK
73130-3329
US

IV. Provider business mailing address

101 N DOUGLAS BLVD STE T
MIDWEST CITY OK
73130-3329
US

V. Phone/Fax

Practice location:
  • Phone: 405-888-5379
  • Fax:
Mailing address:
  • Phone: 405-888-5379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6111
License Number StateOK

VIII. Authorized Official

Name: MS. ANGELA LOYD
Title or Position: REGIONAL MANAGER
Credential:
Phone: 405-888-5379