Organization
DAVID F RANDOLPH DMD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID F RANDOLPH (DENTIST)
(386) 755-4033
Entity
Organization
Contact information
Practice address
1779 SW BARNETT WAY STE 101, LAKE CITY, FL 32025-6957
(386) 755-4033
(386) 755-2581
Mailing address
1779 SW BARNETT WAY STE 101, LAKE CITY, FL 32025-6957
(386) 755-4033
(386) 755-2581
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9899
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60390
BLUE CROSS BLUE SHIELD
FL
Enumeration date
04/02/2007
Last updated
09/23/2009
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