Provider Demographics
NPI:1194934224
Name:O'LAUGHLIN, RANDY J (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:J
Last Name:O'LAUGHLIN
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:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:PINCONNING
Mailing Address - State:MI
Mailing Address - Zip Code:48650-0806
Mailing Address - Country:US
Mailing Address - Phone:989-879-4721
Mailing Address - Fax:989-879-4731
Practice Address - Street 1:224 S MANITOU ST
Practice Address - Street 2:
Practice Address - City:PINCONNING
Practice Address - State:MI
Practice Address - Zip Code:48650-9350
Practice Address - Country:US
Practice Address - Phone:989-879-4721
Practice Address - Fax:989-879-4731
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI131871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice