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General NPI Number Information
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NPI Number | 1649392382
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Entity Type | Individual
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Provider Name | RANDOLPH ALVIN DEGERNESS DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8340 SANGRE DE CRISTO RD SUITE 104
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City | LITTLETON
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State | CO
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Zip | 80127-4248
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Country | US
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Telephone | 303-948-4884
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Fax | 720-922-7734
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Provider Business Mailing Address
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Address Line | 8340 SANGRE DE CRISTO RD SUITE 104
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City | LITTLETON
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State | CO
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Zip | 80127-4248
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Country | US
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Telephone | 303-948-4884
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Fax | 720-922-7734
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DEN000000005149
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D9660
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 899
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License Number State | WY
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