Individual
DR. RANDALL J MCDANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2626 N 76TH ST, WAUWATOSA, WI 53213
(414) 476-9400
Mailing address
2626 N 76TH ST, WAUWATOSA, WI 53213
(414) 476-9400
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
5934-015
WI
Other
Enumeration date
09/15/2006
Last updated
07/08/2007
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