Individual
RANDY J GERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
11400 158TH RD, MAYETTA, KS 66509
(785) 966-8205
(785) 966-8393
Mailing address
11400 158TH RD, MAYETTA, KS 66509
(785) 966-8205
(785) 966-8393
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
514
OKLAHOMA DENTISTRY
OK
01
—
6239
KS DENTAL LICENSE
KS
Enumeration date
11/09/2006
Last updated
07/08/2007
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