Provider Demographics
NPI:1528082625
Name:MCVEY, RANDALL KEITH (DMD, FAGD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:KEITH
Last Name:MCVEY
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N CAMPUS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-3791
Mailing Address - Country:US
Mailing Address - Phone:620-275-9157
Mailing Address - Fax:620-275-0781
Practice Address - Street 1:2501 N CAMPUS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-3791
Practice Address - Country:US
Practice Address - Phone:620-275-9157
Practice Address - Fax:620-275-0781
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS22930OtherBLUECROSSBLUESHIELD