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General NPI Number Information
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NPI Number | 1023179165
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Entity Type | Individual
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Provider Name | RANDALL S RUMINSON DDS
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1918 E MCKELLIPS THUNDERBIRD DENTAL GROUP
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City | MESA
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State | AZ
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Zip | 85203-2866
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Country | US
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Telephone | 480-835-7357
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Fax | 480-649-6088
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Provider Business Mailing Address
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Address Line | 4730 E INDIAN SCHOOL ROAD PMB 120 243
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City | PHOENIX
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State | AZ
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Zip | 85018-5441
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6104
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License Number State | AZ
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