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General NPI Number Information
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NPI Number | 1255318457
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Entity Type | Individual
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Provider Name | RANDOLPH RICHARD STANTON DDS
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Gender | Male
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-8335
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Fax |
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Provider Business Mailing Address
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Address Line | 2721 ELSON GREEN AVE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-6706
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Country | US
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Telephone | 757-287-9968
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10549
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS027136L
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License Number State | PA
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