1962579219 NPI number — CORNERSTONE ENDODONTICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962579219 NPI number — CORNERSTONE ENDODONTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE ENDODONTICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
M MICHAEL RANDALL DDS PA
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962579219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 W 109TH STREET SUITE 325
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-498-3636
Provider Business Mailing Address Fax Number:
913-498-0935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4601 W 109TH STREET SUITE 325
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-498-3636
Provider Business Practice Location Address Fax Number:
913-498-0935
Provider Enumeration Date:
11/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HULS
Authorized Official First Name:
COLLEEN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
913-498-3636

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)