MEDICARE: RANDALL K MCVEY DMD PA

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

General Provider Information

NPI Number	:	1881091288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDALL K MCVEY DMD PA

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	:	OWNER
Name	:	DR. RANDALL KEITH MCVEY
Credential	:	D.M.D., F.A.G.D.
Telephone Number	:	620-275-9157

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	12/01/2014

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