Healthcare Provider Details

I. General information

NPI: 1235204215
Provider Name (Legal Business Name): RANDALL M. KAWAMURA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ROCKLEDGE DR SUITE 420
BETHESDA MD
20817-1809
US

IV. Provider business mailing address

6410 ROCKLEDGE DR SUITE 420
BETHESDA MD
20817-1809
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-5406
  • Fax: 301-530-5408
Mailing address:
  • Phone: 301-530-5406
  • Fax: 301-530-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number06738
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: