Individual
DR. RANDAL DUANE OTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
650 E 25TH ST, KANSAS CITY, MO 64108-2716
(816) 235-2177
Mailing address
301 E ARMOUR BLVD APT 306, KANSAS CITY, MO 64111-1255
(706) 974-6723
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2021010442
MO
1223G0001X
General Practice Dentistry
DN016113
GA
Other
Enumeration date
09/14/2020
Last updated
06/15/2021
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