MEDICARE: DR. CLIFFORD SHERWOOD RANDALL DDS

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	122300000X	Dentist	IL9444A	IL

General Provider Information

NPI Number	:	1295811461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLIFFORD SHERWOOD RANDALL DDS

Provider Business Mailing Address
First Line	:	12219 HARLEM AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463
Country	:	US
Telephone Number	:	708-448-1622
Fax Number	:

Provider Business Practice Location Address
First Line	:	12219 HARLEM AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463
Country	:	US
Telephone Number	:	708-448-1622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	01/11/2026

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