Individual
DR. GREGORY DWIGHT RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7300 BLANCO RD STE 100, SAN ANTONIO, TX 78216-4937
(210) 344-9898
(210) 344-9118
Mailing address
7300 BLANCO RD STE 100, SAN ANTONIO, TX 78216-4937
(210) 344-9898
(210) 344-9118
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D12316
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D12316
STATE LICENSE NUMBER
TX
Enumeration date
11/08/2006
Last updated
12/28/2020
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