Healthcare Provider Details

I. General information

NPI: 1245726082
Provider Name (Legal Business Name): WILLIAM A RANDI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 S RIVER RD STE 102
BEDFORD NH
03110-6916
US

IV. Provider business mailing address

423 E 23RD ST
NEW YORK NY
10010-5011
US

V. Phone/Fax

Practice location:
  • Phone: 603-625-6456
  • Fax: 603-627-6556
Mailing address:
  • Phone: 212-686-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number04755
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: