| 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 |