# RANDALL FAMILY DENTISTRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Chino Valley Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649916628
- **Authorized official:** DR. NICK RANDALL DMD (PRESIDENT)
- **Authorized official phone:** (928) 636-6872

## Contact information

- **Practice address:** 1598 SUSAN A WILLIAMS WAY STE E, CHINO VALLEY, AZ 86323-6171
- **Practice address phone:** (928) 636-6872
- **Mailing address:** 1598 SUSAN A WILLIAMS WAY STE E, CHINO VALLEY, AZ 86323-6171
- **Mailing address phone:** (928) 636-6872

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/11/2022
- **Last updated:** 05/11/2022