Organization
CENTER FOR ORAL RECONSTRUCTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCUS KENNETH RANDALL DMD (OWNER)
(423) 223-5666
Entity
Organization
Contact information
Practice address
2835 NORTHPOINT BLVD STE 105, HIXSON, TN 37343-4862
(423) 223-5666
Mailing address
1373 BRIDGEVIEW DR, CHATTANOOGA, TN 37415-1468
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/30/2025
Last updated
05/30/2025
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