Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. CHARLES JARED RANDALL, DDS
ActiveDR. CHARLES JARED RANDALL, DDS is a Orthodontics healthcare provider located in AMMON, Idaho. NPI 1710035829 is currently active in the NPPES registry. Verify at CMS.
Orthodontics · AMMON, ID
Registration Details
- NPI Number
- 1710035829
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jan 8, 2007 (19.626031930065 yrs)
- Last Updated
- Jul 24, 2009
- License
-
D-3405-OR (ID)
Practice Information
- Address
-
3285 E. 17TH ST.AMMON, ID, 834066758Browse ID providers · Browse ZIP 83406
- Phone
- 2085233380
- Fax
- 2085233077
- Primary Specialty
-
Orthodontics
1223X0400X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.