MEDICARE: IDENTAL PLLC

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

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	:	1932552080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDENTAL PLLC

Provider Business Mailing Address
First Line	:	1700 S SUNNYLANE RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73115-3118
Country	:	US
Telephone Number	:	405-670-5000
Fax Number	:	405-670-5001

Provider Business Practice Location Address
First Line	:	1700 S SUNNYLANE RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73115-3118
Country	:	US
Telephone Number	:	405-670-5000
Fax Number	:	405-670-5001

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. TOBY RHODES
Credential	:	DDS
Telephone Number	:	405-830-7988

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/13/2016

Similar Medicare Providers

1235390808 — VAN PHONG VU DDS
Practice Location Address:

1700 S SUNNYLANE RD
OKLAHOMA CITY, OK
73115-3118

Practice Phone: 405-670-5000
Practice Fax: 405-670-5001

1306951975 — ROBERT K MADDOCK JR. MD
Practice Location Address:

2553 BEVERLY ST
SALT LAKE CITY, UT
84106-3118

Practice Phone: 801-485-5445
Practice Fax:

1891872420 — NORTHLAND FAMILY COUNSELING CENTER, INC.
Practice Location Address:

429 N.E. 69 HIGHWAY
KANSAS CITY, MO
64119-3118

Practice Phone: 816-452-8777
Practice Fax: 816-452-8795

1811042336 — EMPLOYEE HEALTH SERVICES, INC.
Practice Location Address:

423 N. E. 69 HIGHWAY
KANSAS CITY, MO
64119-3118

Practice Phone: 816-455-2224
Practice Fax: 816-454-7511

1922337716 — INDIAN HEALTH SERVICE
Practice Location Address:

3500 CANYON LAKE DR
RAPID CITY, SD
57702-3118

Practice Phone: 605-355-2500
Practice Fax: 605-355-2553

1467750133 — HEART OF AMERICA HOME HEALTH CARE LLC
Practice Location Address:

3118 N 128TH ST
KANSAS CITY, KS
66109-4342

Practice Phone: 913-645-1141
Practice Fax: 913-904-0168

Directions to “IDENTAL PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.