Organization
GREGORY M RANDOLPH DDS & ASSOCIATES, LTD
Active
Other names
Randolph & Associates Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
JENNY GARCIA-ROCHA (SR CREDENTIALING TEAM LEAD)
(972) 869-3789
Entity
Organization
Contact information
Practice address
119 N WILLIAMSBURG DR, BLOOMINGTON, IL 61704-3528
(309) 663-1326
Mailing address
119 N WILLIAMSBURG DR, BLOOMINGTON, IL 61704-3528
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/27/2025
Last updated
07/16/2025
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