MEDICARE: RDC AT 16C, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861020075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RDC AT 16C, LLC

Provider Business Mailing Address
First Line	:	1108 NW 16TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6001
Country	:	US
Telephone Number	:	405-751-4556
Fax Number	:	405-751-4558

Provider Business Practice Location Address
First Line	:	1108 NW 16TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6001
Country	:	US
Telephone Number	:	405-751-4556
Fax Number	:	405-751-4558

Authorized Official
Title or Position	:	INSURANCE COORDINATOR
Name	:	MRS. CHARLA ARMSTRONG
Credential	:
Telephone Number	:	405-751-4556

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	04/01/2020

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Directions to “RDC AT 16C, LLC ” Practice Location

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