Provider Demographics
NPI:1134165376
Name:BISPING, RANDY LEE (DDS MS PC)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:LEE
Last Name:BISPING
Suffix:
Gender:M
Credentials:DDS MS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 HENRY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441
Mailing Address - Country:US
Mailing Address - Phone:231-739-1215
Mailing Address - Fax:231-737-2347
Practice Address - Street 1:3579 HENRY
Practice Address - Street 2:SUITE 140
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441
Practice Address - Country:US
Practice Address - Phone:231-739-1215
Practice Address - Fax:231-737-2347
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0149161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
5617300Medicare ID - Type Unspecified