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General NPI Number Information
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NPI Number | 1447335864
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Entity Type | Organization
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Legal Business Name | RANDY J O LAUGHLIN DDS PC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 224 S MANITOU
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City | PINCONNING
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State | MI
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Zip | 48650-0806
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Country | US
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Telephone | 989-879-4721
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Fax | 989-879-4731
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Provider Business Mailing Address
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Address Line | PO BOX 806
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City | PINCONNING
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State | MI
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Zip | 48650-0806
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Country | US
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Telephone | 989-879-4721
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Fax | 989-879-4731
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDY JAMES O LAUGHLIN
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Credential | DDS
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Telephone | 989-879-4721
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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 | 13187
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License Number State | MI
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