Individual
DR. RANDALL DUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3744 VEST MILL RD, WINSTON SALEM, NC 27103-2912
(336) 760-2500
Mailing address
3744 VEST MILL RD, WINSTON SALEM, NC 27103-2912
(336) 760-2500
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
04630
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04630
DENTAL LICENSE
NC
01
—
163727
CIGNA DMO
NC
01
—
163727
CIGNA DMO
TN
01
—
63611
UNITED CONCORDIA
PA
01
—
92211
BC OF NC
NC
Enumeration date
02/26/2007
Last updated
07/08/2007
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