Healthcare Provider Details

I. General information

NPI: 1770043713
Provider Name (Legal Business Name): RANDY E BUCHMILLER DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29645 RANCHO CALIFORNIA RD STE 121
TEMECULA CA
92591-5285
US

IV. Provider business mailing address

29645 RANCHO CALIFORNIA RD STE 121
TEMECULA CA
92591-5285
US

V. Phone/Fax

Practice location:
  • Phone: 951-676-0296
  • Fax: 951-676-9563
Mailing address:
  • Phone: 951-676-0296
  • Fax: 951-676-9563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: RANDY E BUCHMILLER
Title or Position: PRESIDENT
Credential: DDS MS
Phone: 951-676-0296