NPI | 1487781605 |
---|---|
Former Name | RANDALL L DAVIS |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 16356) |
Additional Taxonomies | 122300000X Dentist (Licence: MA 16356) |
1223P0700X Dentist, Prosthodontics (Licence: MA 16356) | |
Enumeration Date | 2007-02-27 |
Last Update Date | 2016-10-03 |