Individual
DR. RANDALL WAYNE TOOTHAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
328 COUNTRY CLUB DRIVE, FORT DODGE, IA 50501
(515) 302-8079
Mailing address
328 COUNTRY CLUB DRIVE, FORT DODGE, IA 50501
(515) 302-8079
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DDS-09060
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5287
BC/BS
NE
Enumeration date
10/19/2006
Last updated
04/03/2015
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