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General NPI Number Information
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NPI Number | 1861783557
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Entity Type | Organization
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Legal Business Name | RANDALL KIES DDS
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 04/28/2011
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Provider Practice Location Address
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Address Line | 4029 S CAPITAL OF TEXAS HWY STE 109
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City | AUSTIN
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State | TX
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Zip | 78704-7927
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Country | US
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Telephone | 512-445-5866
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Fax |
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Provider Business Mailing Address
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Address Line | 4029 S CAPITAL OF TEXAS HWY STE 109
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City | AUSTIN
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State | TX
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Zip | 78704-7927
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDALL KIES
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Credential | DDS
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Telephone | 512-445-5866
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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 | 21186
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 7037
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11098
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License Number State | TX
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