| Randall Orthodontics, P.a. | |
|
3285 E. 17th St. Ammon ID 83406-6758 | |
| (208) 716-3690 | |
| Not Available |
| Full Name | Randall Orthodontics, P.a. |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 3285 E. 17th St., Ammon, Idaho |
| Authorized Official Name and Position | Charles Jared Randall (OWNER) |
| Authorized Official Contact | 2087163690 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Randall Orthodontics, P.a. 3285 E. 17th St. Ammon ID 83406-6758 Ph: () - | Randall Orthodontics, P.a. 3285 E. 17th St. Ammon ID 83406-6758 Ph: (208) 716-3690 |
| NPI Number | 1902032246 |
|---|---|
| Provider Enumeration Date | 06/01/2009 |
| Last Update Date | 06/01/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902032246 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | D-3405-OR (Idaho) | Primary |
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