Healthcare Provider Details

I. General information

NPI: 1144355603
Provider Name (Legal Business Name): RANDAZZO DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 BRIDGE ST
PELHAM NH
03076-3400
US

IV. Provider business mailing address

43 BRIDGE ST P O BOX 250
PELHAM NH
03076-3400
US

V. Phone/Fax

Practice location:
  • Phone: 603-635-2151
  • Fax: 603-635-9924
Mailing address:
  • Phone: 603-635-2151
  • Fax: 603-635-9924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1270
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3420
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2779
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3390
License Number StateNH

VIII. Authorized Official

Name: DR. RONALD W RANDAZZO
Title or Position: OWNER
Credential: DMD
Phone: 603-635-2151