Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 21586 | MT |
NPI | 1588326235 |
---|---|
Provider Name | Randy Allen Mchenry |
First Address | Belgrade, MT 59714-8995 |
Second Address | Belgrade, MT 59714-8995 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2021 |
Last Update Date | 11/10/2021 |