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General NPI Number Information
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NPI Number | 1528189446
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Entity Type | Organization
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Legal Business Name | DAVID F RANDOLPH DMD PA
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 1779 SW BARNETT WAY STE 101
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City | LAKE CITY
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State | FL
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Zip | 32025-6957
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Country | US
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Telephone | 386-755-4033
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Fax | 386-755-2581
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Provider Business Mailing Address
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Address Line | 1779 SW BARNETT WAY STE 101
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City | LAKE CITY
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State | FL
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Zip | 32025-6957
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Country | US
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Telephone | 386-755-4033
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Fax | 386-755-2581
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Authorized Official
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Title or Position | DENTIST
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Name | DAVID F RANDOLPH
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Credential |
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Telephone | 386-755-4033
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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 | 9899
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License Number State | FL
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