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Provider Information for 1942345251



DR. RANDAL STUART ELLOWAY DDS

Gender: MALE

Individual NPI: 1942345251

Calendar Last Updated: 2010-02-25

Details

Name Value
NPI 1942345251
Enumeration Date 2007-02-21
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 2426 S MAIN ST RED BLUFF
RED BLUFF, CA 96080-4337
United States

Phone: 530-527-6777 | Fax: 530-527-6551
View Map External Link
Primary Practice Address 2426 S MAIN ST
RED BLUFF, CA 96080-4337
United States

Phone: 530-527-6777 | Fax: 530-527-6551
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 40581
Other Identifiers
Issuer State Number
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location