Individual
DR. JAY SCOTT RANDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
530 NW 27TH ST, CORVALLIS, OR 97330-5223
(541) 766-0123
(541) 766-6186
Mailing address
1112 NW CIRCLE BLVD, CORVALLIS, OR 97330-1462
(541) 257-2006
(541) 257-2007
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
D11182
OR
1223G0001X
General Practice Dentistry
044249
NY
1223G0001X
General Practice Dentistry
13269
FL
1223G0001X
General Practice Dentistry
202368
CO
Other
Enumeration date
10/19/2006
Last updated
12/31/2019
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