Organization
RANDOLPH FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROSS D WERNER D.D.S. (MEMBER)
(920) 326-3191
Entity
Organization
Contact information
Practice address
125 N HIGH ST, RANDOLPH, WI 53956-1267
(920) 326-3191
Mailing address
125 N HIGH ST, RANDOLPH, WI 53956-1267
(920) 326-3191
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3858
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801955950
INDIVIDUAL NPI
WI
Enumeration date
01/29/2015
Last updated
01/29/2015
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