Individual
AMELIA RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MS
Contact information
Practice address
1779 SW BARNETT WAY, LAKE CITY, FL 32025-6957
(386) 755-4033
Mailing address
1779 SW BARNETT WAY, LAKE CITY, FL 32025-6957
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
FR3349669
FL
Other
Enumeration date
12/02/2013
Last updated
12/02/2013
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