Provider Demographics
NPI:1396957460
Name:ALKIRE, RANDY GAIL
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:GAIL
Last Name:ALKIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 HOLLY AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1260
Mailing Address - Country:US
Mailing Address - Phone:505-323-5406
Mailing Address - Fax:505-797-0156
Practice Address - Street 1:12000 HOLLY AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-1260
Practice Address - Country:US
Practice Address - Phone:505-323-5406
Practice Address - Fax:505-891-3169
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ67761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics