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Individual
DR. RANDALL DUCK
Active
Individual
DR. RANDALL DUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
04630
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04630
DENTAL LICENSE
NC
01
—
163727
CIGNA DMO
NC
01
—
163727
CIGNA DMO
TN
01
—
63611
UNITED CONCORDIA
PA
01
—
92211
BC OF NC
NC
Enumeration date
02/26/2007
Last updated
07/08/2007
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