Organization
RANDOM LAKE DENTISTRY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOOMAN ABDOLISERESHKI D.D.S (OWNER)
(920) 892-8466
Entity
Organization
Contact information
Practice address
37 HICKORY DR, RANDOM LAKE, WI 53075-1675
(920) 994-4367
Mailing address
62 S PLEASANT VIEW RD, PLYMOUTH, WI 53073-4954
(920) 892-8466
(920) 892-8467
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/20/2024
Last updated
09/20/2024
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