MEDICARE: DR. TOBY M RHODES 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	122300000X	Dentist	6138	OK

General Provider Information

NPI Number	:	1619106457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOBY M RHODES D.D.S.

Provider Business Mailing Address
First Line	:	4912 N QUAPAH PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2563
Country	:	US
Telephone Number	:	405-830-7988
Fax Number	:

Provider Business Practice Location Address
First Line	:	4912 N QUAPAH PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2563
Country	:	US
Telephone Number	:	405-830-7988
Fax Number	:

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

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/14/2009

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