MEDICARE: RC RHOADS DENTAL, PA

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	61157	KS
2	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1508214917	OTHER		NPI

General Provider Information

NPI Number	:	1568976041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RC RHOADS DENTAL, PA

Provider Business Mailing Address
First Line	:	6700 W 121ST ST STE 101
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66209-2028
Country	:	US
Telephone Number	:	913-451-2540
Fax Number	:

Provider Business Practice Location Address
First Line	:	6700 W 121ST ST STE 101
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66209-2028
Country	:	US
Telephone Number	:	913-451-2540
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. RICHARD DEAN RHOADS JR.
Credential	:	DDS
Telephone Number	:	308-293-1061

Provider Enumeration Date	:	11/20/2017
Last Update Date	:	03/08/2023

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