Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DS025531L | PA |
NPI | 1033264445 |
---|---|
Provider Name | Dr. Randy J Ashoff |
First Address | Erie, PA 16506-3220 |
Second Address | Erie, PA 16506-3220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 27/08/2007 |