| Randolph Family Dental Llc | |
|
125 N High St Randolph WI 53956-1267 | |
| (920) 326-3191 | |
| Not Available |
| Full Name | Randolph Family Dental Llc |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| 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 |