Randolph Family Dental Llc | |
125 N High St Randolph WI 53956-1267 | |
(920) 326-3191 | |
Not Available |
Full Name | Randolph Family Dental Llc |
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Speciality | Dentist - General Practice |
Location | 125 N High St, Randolph, Wisconsin |
Authorized Official Name and Position | Ross D Werner (MEMBER) |
Authorized Official Contact | 9203263191 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Randolph Family Dental Llc 125 N High St Randolph WI 53956-1267 Ph: (920) 326-3191 | Randolph Family Dental Llc 125 N High St Randolph WI 53956-1267 Ph: (920) 326-3191 |
NPI Number | 1154711190 |
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Provider Enumeration Date | 01/29/2015 |
Last Update Date | 01/29/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154711190 | NPI | - | NPPES |
1801955950 | Other | WI | INDIVIDUAL NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 3858 (Wisconsin) | Primary |