MEDICARE: DR. RICHARD CHARLES TATE 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	1223G0001X	General Practice Dentistry	2524	AR

General Provider Information

NPI Number	:	1881798809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD CHARLES TATE D.D.S.

Provider Business Mailing Address
First Line	:	11327 ARCADE DR
Second Line	:	SUITE D
City	:	LITTLE ROCK
State	:	AR
Zip	:	72212-4015
Country	:	US
Telephone Number	:	501-225-3977
Fax Number	:	501-225-3988

Provider Business Practice Location Address
First Line	:	11327 ARCADE DR
Second Line	:	SUITE D
City	:	LITTLE ROCK
State	:	AR
Zip	:	72212-4015
Country	:	US
Telephone Number	:	501-225-3977
Fax Number	:	501-225-3988

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	07/08/2007

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