Individual
RANDIN RAWLINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
90 HOPE DR, MOUNTAIN HOME AFB, ID 83648-1057
(208) 828-7300
Mailing address
90 HOPE DR, MOUNTAIN HOME AFB, ID 83648-1057
(208) 828-7900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7942
NE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2023
Last updated
09/11/2024
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