Individual
MARK LANE RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
16A HOLLIS ST., GROTON, MA 01450
(978) 448-6814
(978) 448-6835
Mailing address
112 SCENIC DR, LEOMINSTER, MA 01453-3451
(978) 534-5608
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14968
MA
Other
Enumeration date
12/22/2006
Last updated
07/08/2007
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