Individual
DR. RANDOLPH CHARLES DANIEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5634 N HENRY BLVD, SUITE C, STOCKBRIDGE, GA 30281-3418
(770) 474-6900
(770) 474-8276
Mailing address
5634 N HENRY BLVD, SUITE C, STOCKBRIDGE, GA 30281-3418
(770) 474-6900
(770) 474-8276
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9238
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0001996698
—
GA
Enumeration date
10/19/2006
Last updated
07/08/2007
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