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General NPI Number Information
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NPI Number | 1629617980
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Entity Type | Organization
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Legal Business Name | RANDALL NIEDERKOHR,D.D.S,INC.
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Dates
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Enumeration Date | 01/03/2020
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 27 ST LAWRENCE DR STE 109
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City | TIFFIN
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State | OH
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Zip | 44883-8314
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Country | US
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Telephone | 419-447-7337
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Fax | 419-447-7003
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Provider Business Mailing Address
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Address Line | 27 ST LAWRENCE DR STE 109
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City | TIFFIN
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State | OH
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Zip | 44883-8314
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Country | US
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Telephone | 419-447-7337
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Fax | 419-447-7003
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDLL EUGENE NIEDERKOHR
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Credential | D.D.S.
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Telephone | 323-816-3581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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