Organization
BRYAN RANDOLPH DDS A PROFESSIONAL DENTAL CORP.
Active
Other names
The Tooth Station
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN RANDOLPH DDS (OWNER/DENTIST)
(916) 419-0020
Entity
Organization
Contact information
Practice address
1954 DEL PASO RD, SUITE 101, SACRAMENTO, CA 95834-7706
(916) 419-0020
(916) 419-6787
Mailing address
1954 DEL PASO RD, SUITE 101, SACRAMENTO, CA 95834-7706
(916) 419-0020
(916) 419-6787
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
41779
CA
Other
Enumeration date
01/15/2014
Last updated
01/15/2014
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