Provider Demographics
NPI:1881774032
Name:KREUTER, RANDY LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:LEE
Last Name:KREUTER
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 1:304 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812
Mailing Address - Country:US
Mailing Address - Phone:740-622-9557
Mailing Address - Fax:740-622-8386
Practice Address - Street 1:304 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812
Practice Address - Country:US
Practice Address - Phone:740-622-9557
Practice Address - Fax:740-622-8386
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300154651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice