=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275779712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VOSS & BECK FAMILY DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2009
-----------------------------------------------------
Last Update Date | 01/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 STATION WAY STE A
-----------------------------------------------------
City | ARROYO GRANDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93420-3348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-489-6800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 STATION WAY STE A
-----------------------------------------------------
City | ARROYO GRANDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93420-3348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-489-6800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. RANDALL CURTIS VOSS
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 805-489-6800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 34042
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------