Provider Demographics
NPI:1003241860
Name:FAECHER, RANDY SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:SCOTT
Last Name:FAECHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 SHREVEPORT HWY
Mailing Address - Street 2:DENTAL SERVICE, ALEXANDRIA VA HEALTHCARE SYSTEM
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4044
Mailing Address - Country:US
Mailing Address - Phone:318-466-2567
Mailing Address - Fax:318-466-2567
Practice Address - Street 1:2495 SHREVEPORT HWY
Practice Address - Street 2:DENTAL SERVICE, ALEXANDRIA VA HEALTHCARE SYSTEM
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4044
Practice Address - Country:US
Practice Address - Phone:318-466-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 12491122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist