Organization
RANDALL W HALLIDAY DDS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL W HALLIDAY DDS (PRESIDENT)
(909) 793-2629
Entity
Organization
Contact information
Practice address
245 TERRACINA BLVD, SUITE 211A, REDLANDS, CA 92373-4852
(909) 793-2629
(909) 798-2851
Mailing address
245 TERRACINA BLVD, SUITE 211A, REDLANDS, CA 92373-4852
(909) 793-2629
(909) 798-2851
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
22609
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B22609
—
CA
Enumeration date
09/09/2010
Last updated
09/09/2010
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