Healthcare Provider Details

I. General information

NPI: 1689664427
Provider Name (Legal Business Name): RANDY ADAMS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W BROAD ST
RICHMOND VA
23220-4219
US

IV. Provider business mailing address

300 W BROAD ST
RICHMOND VA
23220-4219
US

V. Phone/Fax

Practice location:
  • Phone: 804-780-2888
  • Fax: 804-643-1916
Mailing address:
  • Phone: 804-780-2888
  • Fax: 804-643-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4545
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: