Provider Demographics
NPI:1124191382
Name:ALTMANN, RANDALL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:J
Last Name:ALTMANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 N ASSEMBLY ST
Mailing Address - Street 2:VA MEDICAL CENTER, DENTAL SERVICE (160)
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6185
Mailing Address - Country:US
Mailing Address - Phone:509-434-7316
Mailing Address - Fax:509-434-7145
Practice Address - Street 1:4815 N ASSEMBLY ST
Practice Address - Street 2:VA MEDICAL CENTER, DENTAL SERVICE (160)
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6185
Practice Address - Country:US
Practice Address - Phone:509-434-7316
Practice Address - Fax:509-434-7145
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE92941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice