Organization
RANDALL L. FOTO D.D.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL L FOTO D.D.S. (PRESIDENT)
(985) 626-4447
Entity
Organization
Contact information
Practice address
645 LOTUS DRIVE N, SUITE B, MANDEVILLE, LA 70471
(985) 626-4447
(985) 674-6688
Mailing address
645 LOTUS DR N, SUITE B, MANDEVILLE, LA 70471-3304
(985) 626-4447
(985) 674-6688
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
4782
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114315876
NPI TYPE 2 FOR MEDICARE
LA
01
—
1538261128
DENTAL NPI
LA
Enumeration date
08/19/2015
Last updated
08/19/2015
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