Individual
CARLA MARTA RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7555 US12, ONSTED, MI 49265-9822
(517) 467-4423
Mailing address
3439 DOUGLAS RD, WILLIAMSTON, MI 48895-9504
(517) 614-4599
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901019520
MI
Other
Enumeration date
06/06/2007
Last updated
10/24/2007
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