Organization
RANDALL ORTHODONTICS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES JARED RANDALL D.D.S., M.S. (OWNER)
(208) 716-3690
Entity
Organization
Contact information
Practice address
3285 E. 17TH ST., AMMON, ID 83406-6758
(208) 716-3690
Mailing address
3285 E. 17TH ST., AMMON, ID 83406-6758
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D-3405-OR
ID
Other
Enumeration date
06/01/2009
Last updated
06/01/2009
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