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General NPI Number Information
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NPI Number | 1043301021
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Entity Type | Individual
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Provider Name | RANDALL J KIRWAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 819 MAIN ST
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City | SABETHA
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State | KS
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Zip | 66534-1826
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Country | US
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Telephone | 785-284-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 70222 639 BLVD
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City | DAWSON
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State | NE
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Zip | 68337-1705
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Country | US
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Telephone | 402-855-2156
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 60151
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License Number State | KS
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