Doctor Name: | MR. RANDY L TOWNSEND |
NPI Number: | 1467571612 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LD |
License Number: | DTDO629849 |
Business Practice Address: | 1228 Main St Sweet Home, OR - 973861608 |
Business Phone Number: | 5414092499 |
Business Fax Number: | |
Mailing Address: | 1228 Main St, SWEET HOME |
State: | OR |
Postal Code: | 973861608 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/28/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 122400000X |
License Number: | DTDO629849 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Denturist |
Taxonomy Specialization: | |
Taxonomy Definition: |