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General NPI Number Information
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NPI Number | 1336119775
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Entity Type | Individual
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Provider Name | RANDALL J. AVERS DENTIST
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Gender | Male
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 250 WOOD RD
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City | ANNAPOLIS
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State | MD
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Zip | 21402-1257
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Country | US
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Telephone | 410-293-4378
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Fax | 410-293-4831
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Provider Business Mailing Address
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Address Line | 250 WOOD RD
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City | ANNAPOLIS
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State | MD
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Zip | 21402-1257
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Country | US
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Telephone | 410-293-4378
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Fax | 410-293-4831
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30-01-8322
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License Number State | OH
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