Individual
CHANTELLE ELIZABAETH RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1978 HOLLAND AVE, PORT HURON, MI 48060-1520
(810) 987-7511
Mailing address
1978 HOLLAND AVE, PORT HURON, MI 48060-1520
(810) 987-7511
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901601063
MI
Other
Enumeration date
07/25/2021
Last updated
07/26/2021
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