Healthcare Provider Details

I. General information

NPI: 1528371903
Provider Name (Legal Business Name): RANDALL L. SANDLIN DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 STRATFORD RD SE
DECATUR AL
35601-6003
US

IV. Provider business mailing address

1318 STRATFORD RD. S.E.
DECATUR AL
35601-6026
US

V. Phone/Fax

Practice location:
  • Phone: 256-355-0259
  • Fax: 256-355-0587
Mailing address:
  • Phone: 256-355-0259
  • Fax: 256-355-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURA PARHAM
Title or Position: FRONT OFFICE
Credential:
Phone: 256-355-0259