MEDICARE: RANDLE T. CARR, DDS, P.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00008137	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	602-330-302	OTHER	WA	WA UBI NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053326538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDLE T. CARR, DDS, P.S.

Provider Business Mailing Address
First Line	:	3400 SQUALICUM PKWY
Second Line	:	SUITE 107
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1933
Country	:	US
Telephone Number	:	360-734-9926
Fax Number	:	360-734-0855

Provider Business Practice Location Address
First Line	:	3400 SQUALICUM PKWY
Second Line	:	SUITE 107
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1933
Country	:	US
Telephone Number	:	360-734-9926
Fax Number	:	360-734-0855

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RANDLE T CARR
Credential	:	DDS
Telephone Number	:	360-734-9926

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	05/14/2010

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