Provider Demographics
NPI:1003842279
Name:RAND L. REDFERN, DDS, PC
Entity Type:Organization
Organization Name:RAND L. REDFERN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAND
Authorized Official - Middle Name:L
Authorized Official - Last Name:REDFERN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-599-9090
Mailing Address - Street 1:669 CITADEL DR E
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5313
Mailing Address - Country:US
Mailing Address - Phone:719-599-9090
Mailing Address - Fax:719-573-9091
Practice Address - Street 1:669 CITADEL DR E
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5313
Practice Address - Country:US
Practice Address - Phone:719-599-9090
Practice Address - Fax:719-573-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHD1040661223G0001X, 1223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Multi-Specialty