Provider Demographics
NPI:1548209117
Name:ATKINSON, RANDY WALKER (DDS)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:WALKER
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 NW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7032
Mailing Address - Country:US
Mailing Address - Phone:405-607-0404
Mailing Address - Fax:
Practice Address - Street 1:1016 NW 42ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-6807
Practice Address - Country:US
Practice Address - Phone:405-525-3000
Practice Address - Fax:405-525-3977
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice