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NPI Code Detail

MEDICARE: RANDY R CIEPLUCH

MEDICARE: RANDY R CIEPLUCH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center2260-015WI

General Provider Information

NPI Number : 1043483357
Entity Type Code : Organization
Provider Name (Legal Business Name) : RANDY R CIEPLUCH
Provider Business Mailing Address
First Line : 3500 W LISBON AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53208-1953
Country : US
Telephone Number :
Fax Number : 414-342-1008
Provider Business Practice Location Address
First Line : 3500 W LISBON AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53208-1953
Country : US
Telephone Number : 414-342-0378
Fax Number : 414-342-1008
Authorized Official
Title or Position : OWNER
Name : DR. RANDY ROBERT CIEPLUCH
Credential : DDS
Telephone Number : 414-342-0378
Provider Enumeration Date : 04/08/2008
Last Update Date : 06/20/2008

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