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General NPI Number Information
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NPI Number | 1316397011
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Entity Type | Organization
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Legal Business Name | RANDALL C MARKARIAN DMD, MS, PC
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 10 PARK PL
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City | SWANSEA
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State | IL
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Zip | 62226-2967
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Country | US
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Telephone | 618-236-7846
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Fax | 618-236-0842
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Provider Business Mailing Address
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Address Line | 10 PARK PL
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City | SWANSEA
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State | IL
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Zip | 62226-2967
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Country | US
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Telephone | 618-236-7846
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Fax | 618-236-0842
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Authorized Official
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Title or Position | ORTHODONTIST/OWNER
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Name | DR. RANDALL C MARKARIAN
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Credential | DMD, MS
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Telephone | 618-236-7846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019-022945
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License Number State | IL
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