Provider Demographics
NPI:1689731358
Name:ROHMILLER, RANDALL SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:SCOTT
Last Name:ROHMILLER
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 1:2700 MC CLELLAND BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1623
Mailing Address - Country:US
Mailing Address - Phone:417-782-7810
Mailing Address - Fax:417-782-7805
Practice Address - Street 1:2700 MC CLELLAND BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1623
Practice Address - Country:US
Practice Address - Phone:417-782-7810
Practice Address - Fax:417-782-7805
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODEO152681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice