Provider Demographics
NPI:1861020075
Name:RDC AT 16C, LLC
Entity Type:Organization
Organization Name:RDC AT 16C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-751-4556
Mailing Address - Street 1:1108 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6001
Mailing Address - Country:US
Mailing Address - Phone:405-751-4556
Mailing Address - Fax:405-751-4558
Practice Address - Street 1:1108 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6001
Practice Address - Country:US
Practice Address - Phone:405-751-4556
Practice Address - Fax:405-751-4558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANCE R. SCHMIDT, DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200045990AMedicaid