John Randolph Iddings in Glen Arm - Prosthodontics
John Randolph Iddings - NPI 1417908179
John Randolph Iddings is a Prosthodontics in Glen Arm, Maryland. John Randolph Iddings practices all healthcare services and medical treatments related to Prosthodontics. The NPI Number for John Randolph Iddings is 1417908179. The last update date is 2007-07-08.
John Randolph Iddings's current location address is 4310 Crab Orchard Rd, Glen Arm, Maryland. You can contact this provider via phone number 4106057057 and fax number 4106057819. The mailing address for John Randolph Iddings is 4310 Crab Orchard Rd, Glen Arm, Maryland. To know further, please read the information below!
Provider Profile Detail
| Provider Name | John Randolph Iddings |
|---|---|
| Address | 4310 Crab Orchard Rd, Glen Arm, Maryland |
| Phone Number | 4106057057 |
| Fax Number | 4106057819 |
| Sole Proprietor | X |
| Credentials | DDS0 |
NPI Number Detail
| NPI Number | 1417908179 |
|---|---|
| Provider Enumeration Date | 2006-05-15 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 4310 Crab Orchard Rd |
|---|---|
| City | Glen Arm |
| State | Maryland (MD) |
| Post Code | 210579752 |
| Phone Number | 4106057057 |
| Fax Number | 4106057819 |
Provider's Primary Taxonomy Detail
| Speciality | Prosthodontics |
|---|---|
| Taxonomy | 1223P0700X |
| Licence No | 4171 |
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Definition: That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial |
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Where is the John Randolph Iddings located?
The John Randolph Iddings is located at 4310 Crab Orchard Rd, Glen Arm, MD 210579752.
When was the John Randolph Iddings's 1417908179 issued?
The John Randolph Iddings's 1417908179 was issued on 2006-05-15.
On what date did the Centers for Medicare & Medicaid Services issue the 1417908179 to John Randolph Iddings?
The John Randolph Iddings received its 1417908179 assignment from the Centers for Medicare & Medicaid Services on 2006-05-15.
When was the John Randolph Iddings's information last updated?
The John Randolph Iddings's information was last updated on 2007-07-08.
When was the information pertaining to John Randolph Iddings most recently updated or revised?
The details related to John Randolph Iddings, including its address, specialty, and other relevant information, were last updated or revised on 2007-07-08.
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