Individual
CARRIE MD RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
506 W MARINE WAY, KODIAK, AK 99615-7311
(907) 486-3269
Mailing address
506 W MARINE WAY, KODIAK, AK 99615-7311
(907) 486-3269
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1346
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346
AK OCCUPATIONAL LICENSE
AK
Enumeration date
08/02/2010
Last updated
09/30/2016
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