Individual
DR. CHARLES D RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
875 MAMARONECK AVE, SUITE 302, MAMARONECK, NY 10543-1900
(914) 835-6004
(914) 835-6055
Mailing address
875 MAMARONECK AVE, SUITE 302, MAMARONECK, NY 10543-1900
(914) 835-6004
(914) 835-6055
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
028137
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02577842
—
NY
Enumeration date
01/02/2007
Last updated
02/03/2014
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