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General NPI Number Information
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NPI Number | 1699082818
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Entity Type | Organization
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Legal Business Name | RANDALL W HALLIDAY DDS, INC
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 09/09/2010
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Provider Practice Location Address
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Address Line | 245 TERRACINA BLVD SUITE 211A
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City | REDLANDS
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State | CA
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Zip | 92373-4852
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Country | US
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Telephone | 909-793-2629
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Fax | 909-798-2851
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Provider Business Mailing Address
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Address Line | 245 TERRACINA BLVD SUITE 211A
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City | REDLANDS
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State | CA
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Zip | 92373-4852
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Country | US
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Telephone | 909-793-2629
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Fax | 909-798-2851
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDALL W HALLIDAY
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Credential | DDS
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Telephone | 909-793-2629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 22609
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License Number State | CA
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