MEDICARE: RICHARD J RAND JR DMD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN6965	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	609637	OTHER		UNITED CONCORDIA
2	Z09609	OTHER	MA	BCBS MA
3	66372	OTHER	FL	BCBS FL

General Provider Information

NPI Number	:	1215068861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD J RAND JR DMD PA

Provider Business Mailing Address
First Line	:	428 E OLYMPIA AVE
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3836
Country	:	US
Telephone Number	:	941-639-8030
Fax Number	:	941-639-1901

Provider Business Practice Location Address
First Line	:	428 E OLYMPIA AVE
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3836
Country	:	US
Telephone Number	:	941-639-8030
Fax Number	:	941-639-1901

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD JOSEPH RAND JR.
Credential	:	D.M.D.
Telephone Number	:	941-639-8030

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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