Individual provider · Type 1 NPI
Charles Jared Randall, DDS
Orthodontics and Dentofacial Orthopedics Dentistry · Ammon, ID
Practice location
3285 E. 17th St.
Ammon, ID 83406-6758
Fax (208) 523-3077
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry Primary | 1223X0400X | D-3405-OR (ID) |
Orthodontics and Dentofacial Orthopedics Dentistry: That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of funct…
Another provider at this address
About NPI 1710035829
Charles Jared Randall, DDS's National Provider Identifier is 1710035829, issued on Jan 8, 2007. The primary taxonomy on file is Orthodontics and Dentofacial Orthopedics Dentistry (1223X0400X), and the practice location is in Ammon, ID. The record was last updated on Jul 24, 2009.