Provider Demographics
NPI:1942292859
Name:HASKINS, R. RANDALL (DDS, MAGD)
Entity Type:Individual
Prefix:DR
First Name:R.
Middle Name:RANDALL
Last Name:HASKINS
Suffix:
Gender:M
Credentials:DDS, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 W BLUE STARR DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-2404
Mailing Address - Country:US
Mailing Address - Phone:918-341-4844
Mailing Address - Fax:918-341-4852
Practice Address - Street 1:1495 W BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-2404
Practice Address - Country:US
Practice Address - Phone:918-341-4844
Practice Address - Fax:918-341-4852
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK49301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice