Provider Demographics
NPI:1962507897
Name:RAHILL, RANDALL OTTO (DDS)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:OTTO
Last Name:RAHILL
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 1:3530 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73122-1618
Mailing Address - Country:US
Mailing Address - Phone:405-942-2842
Mailing Address - Fax:
Practice Address - Street 1:3530 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73122-1618
Practice Address - Country:US
Practice Address - Phone:405-942-2842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice