Healthcare Provider Details

I. General information

NPI: 1639579519
Provider Name (Legal Business Name): THOMAS SCOTT RANDALL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 08/19/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 ZIMMERMAN TRL
BILLINGS MT
59102-7653
US

IV. Provider business mailing address

1601 ZIMMERMAN TRL STE 1
BILLINGS MT
59102-7654
US

V. Phone/Fax

Practice location:
  • Phone: 406-248-3303
  • Fax:
Mailing address:
  • Phone: 406-248-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number23715
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: