IndividualActive
Charles Randall, DDS
NPI 1710035829 · Orthodontics and Dentofacial Orthopedics Dentistry · Ammon, ID
Provider details
- NPI number
- 1710035829
- Entity type
- Individual
- Primary specialty
- Orthodontics and Dentofacial Orthopedics DentistryDental Providers
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- License
- D-3405-OR (ID)
Specialties & taxonomies
Dental Providers
Practice location
3285 E. 17th St.
Ammon, ID 83406-6758
Phone: (208) 523-3380
Fax: (208) 523-3077
Approximate (ZIP-level) locationGet directions
Mailing address
3285 E. 17th St.
Ammon, ID 83406-6758
Registry dates
- Enumerated
- 2007-01-08
- Last updated
- 2009-07-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.