Provider Demographics
NPI:1821069105
Name:METZLER, RANDY STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:STEPHEN
Last Name:METZLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:S
Other - Last Name:METZLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:501 SE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-8730
Mailing Address - Country:US
Mailing Address - Phone:316-284-2930
Mailing Address - Fax:316-284-2141
Practice Address - Street 1:501 SE 36TH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-8730
Practice Address - Country:US
Practice Address - Phone:316-284-2930
Practice Address - Fax:316-284-2141
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS600581223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics