# RANDOLPH P PLATT DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Platt Comprehensive Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811254246
- **Authorized official:** DR. RANDOLPH PATTESON PLATT D.D.S. (PRESIDENT-OWNER)
- **Authorized official phone:** (928) 337-2522

## Contact information

- **Practice address:** 100 NORTH 13TH WEST, ST. JOHNS, AZ 85936
- **Practice address phone:** (928) 337-2522
- **Practice address fax:** (928) 337-4881
- **Mailing address:** PO BOX 930, ST. JOHNS, AZ 85936-0930
- **Mailing address phone:** (928) 337-2522
- **Mailing address fax:** (928) 337-2522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2706 | AZ | Yes |

## Other

- **Enumeration date:** 04/23/2012
- **Last updated:** 04/23/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 081282-001 | STATE AHCCCS PROGRAM | AZ |