Provider Demographics
NPI:1205914124
Name:PAS, RANDY JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:JOSEPH
Last Name:PAS
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:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:IA
Mailing Address - Zip Code:51351-0141
Mailing Address - Country:US
Mailing Address - Phone:712-338-2449
Mailing Address - Fax:712-338-4239
Practice Address - Street 1:UNITS 5 & 6 LAKELAND SQUARE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:IA
Practice Address - Zip Code:51351
Practice Address - Country:US
Practice Address - Phone:712-338-2449
Practice Address - Fax:712-338-4239
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist