Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN 12491 | FL |
NPI | 1003241860 |
---|---|
Provider Name | Dr. Randy Scott Faecher |
First Address | Pineville, LA 71360-4044 |
Second Address | Pineville, LA 71360-4044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2013 |
Last Update Date | 11/09/2013 |