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General NPI Number Information
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NPI Number | 1508251331
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Entity Type | Organization
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Legal Business Name | RANDALL & RANDALL DENTAL ASSOCIATION
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 457 W MAIN ST
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City | LEWISVILLE
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State | TX
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Zip | 75057-3771
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Country | US
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Telephone | 972-436-2431
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Fax | 972-436-5633
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Provider Business Mailing Address
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Address Line | 457 W MAIN ST
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City | LEWISVILLE
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State | TX
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Zip | 75057-3771
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Country | US
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Telephone | 972-436-2431
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Fax | 972-436-5633
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW WARREN RANDALL
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Credential | DDS
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Telephone | 972-436-2431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19682
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License Number State | TX
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