Randolph Family Dental Llc

NPI 1154711190 - Dentist - 1223G0001X

NPI Details
NPI 1154711190
Enumeration Date 01/29/2015
Last Updated 01/29/2015
Entity Type Healthcare Provider
Active Over 1 year ago
Authorized Information
Name ROSS D ROSS
Position MEMBER
Phone (920) 326-3191
Fax
Practice Location
125 N HIGH ST
RANDOLPH WI, 53956-1267, US
Phone (920) 326-3191
Fax
Business Location
125 N HIGH ST
RANDOLPH WI, 53956-1267, US
Phone (920) 326-3191
Fax
Toxanomy
Taxonomy Code 1223G0001X
License State Wisconsin
License Number 3858
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According to our database, Randolph Family Dental Llc NPI is 1154711190, taxonomy code is 1223G0001X and license number is 3858, license state is located at Wisconsin. Randolph Family Dental Llc physically located at 125 N High St, Randolph WI, 53956-1267. NPI Number 1033115704 has the healthcare provider type.

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1154711190 NPI number is provided on an as is basis without warranty of any kind. 1154711190 is maintained by the National Plan & Provider Enumeration System. The contents of Randolph Family Dental Llc are for informational purposes only.