MEDICARE: DR. RANDALL KEITH MCVEY D.M.D., F.A.G.D.

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
1	1223G0001X	General Practice Dentistry	6020	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22930	OTHER	KS	BLUECROSSBLUESHIELD

General Provider Information

NPI Number	:	1528082625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL KEITH MCVEY D.M.D., F.A.G.D.

Provider Business Mailing Address
First Line	:	2501 N CAMPUS DR
Second Line	:	SUITE 100
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-3791
Country	:	US
Telephone Number	:	620-275-9157
Fax Number	:	620-275-0781

Provider Business Practice Location Address
First Line	:	2501 N CAMPUS DR
Second Line	:	SUITE 100
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-3791
Country	:	US
Telephone Number	:	620-275-9157
Fax Number	:	620-275-0781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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