Provider Demographics
NPI:1275928137
Name:RANDALL K HAHN DDS
Entity Type:Organization
Organization Name:RANDALL K HAHN DDS
Other - Org Name:VIBORG DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-326-5612
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:VIBORG
Mailing Address - State:SD
Mailing Address - Zip Code:57070-0156
Mailing Address - Country:US
Mailing Address - Phone:605-326-5612
Mailing Address - Fax:
Practice Address - Street 1:103 W PIONEER
Practice Address - Street 2:
Practice Address - City:VIBORG
Practice Address - State:SD
Practice Address - Zip Code:57070
Practice Address - Country:US
Practice Address - Phone:605-326-5612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM413122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty