Provider Demographics
NPI:1467787747
Name:RANDY G. ALKIRE,DDS,MS,PC
Entity Type:Organization
Organization Name:RANDY G. ALKIRE,DDS,MS,PC
Other - Org Name:RIO RANCHO ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:ALKIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PC
Authorized Official - Phone:505-892-5749
Mailing Address - Street 1:1316 JACKIE RD SE
Mailing Address - Street 2:SUITE #300
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6618
Mailing Address - Country:US
Mailing Address - Phone:505-892-5749
Mailing Address - Fax:505-212-0673
Practice Address - Street 1:1316 JACKIE RD SE
Practice Address - Street 2:SUITE #300
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6618
Practice Address - Country:US
Practice Address - Phone:505-892-5749
Practice Address - Fax:505-212-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD19581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty