Individual
RANDALL SCOTT CLASEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.D.
Contact information
Practice address
696 NE WINCHESTER ST, ROSEBURG, OR 97470-3260
(541) 673-2724
(547) 440-6906
Mailing address
696 NE WINCHESTER ST, ROSEBURG, OR 97470-3260
(541) 673-2724
(547) 440-6906
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DTDO355212
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86-114979
TAX ID
OR
Enumeration date
07/10/2013
Last updated
07/30/2013
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