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General NPI Number Information
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NPI Number | 1760207658
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Entity Type | Individual
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Provider Name | SANDRA RANDOLPH RDH, OMT
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Gender | Female
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 52 CRAZY HORSE LN
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City | BELFRY
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State | MT
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Zip | 59008-9510
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Country | US
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Telephone | 406-201-8259
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 238
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City | BELFRY
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State | MT
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Zip | 59008-0238
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Country | US
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Telephone | 253-226-6220
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DEN-RDH-LIC-28199
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | DEN-RDH-LIC-28199
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License Number State | MT
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