Individual
DR. RANDOLPH KEN SHOUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
14297 BERGEN BLVD # 100, NOBLESVILLE, IN 46060-3358
(317) 776-1100
(317) 776-1129
Mailing address
14297 BERGEN BLVD # 100, NOBLESVILLE, IN 46060-3358
(317) 776-1100
(317) 776-1129
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008036A
IN
Other
Enumeration date
07/31/2006
Last updated
10/22/2008
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