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General NPI Number Information
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NPI Number | 1063516128
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Entity Type | Individual
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Provider Name | RANDALL L BITTNER DMD
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Gender | Male
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 1930 N MAIN ST
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City | SUFFOLK
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State | VA
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Zip | 23434-4373
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Country | US
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Telephone | 757-922-4114
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Fax |
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Provider Business Mailing Address
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Address Line | 2529 ALLIE NICOLE CIR APT 203
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-7010
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Country | US
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Telephone | 757-573-8448
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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 | 0401008030
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License Number State | VA
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