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General NPI Number Information
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NPI Number | 1043483357
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Entity Type | Organization
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Legal Business Name | RANDY R CIEPLUCH
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 3500 W LISBON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53208-1953
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Country | US
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Telephone | 414-342-0378
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Fax | 414-342-1008
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Provider Business Mailing Address
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Address Line | 3500 W LISBON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53208-1953
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Country | US
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Telephone |
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Fax | 414-342-1008
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDY ROBERT CIEPLUCH
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Credential | DDS
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Telephone | 414-342-0378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2260-015
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License Number State | WI
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