| Bryan Randolph Dds A Professional Dental Corporation | |
|
1621 Creekside Dr Suite 101 Folsom CA 95630-3493 | |
| (916) 984-6747 | |
| (916) 984-6746 |
| Full Name | Bryan Randolph Dds A Professional Dental Corporation |
|---|---|
| Speciality | Dentist |
| Location | 1621 Creekside Dr, Folsom, California |
| Authorized Official Name and Position | Bryan C Randolph (OWNER) |
| Authorized Official Contact | 9169846747 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bryan Randolph Dds A Professional Dental Corporation 1621 Creekside Dr Suite 101 Folsom CA 95630-3493 Ph: (916) 984-6747 | Bryan Randolph Dds A Professional Dental Corporation 1621 Creekside Dr Suite 101 Folsom CA 95630-3493 Ph: (916) 984-6747 |
| NPI Number | 1164631776 |
|---|---|
| Provider Enumeration Date | 05/21/2007 |
| Last Update Date | 01/06/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164631776 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 41779 (California) | Primary |
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