Provider Demographics
NPI:1013032291
Name:RANDOLPH DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:RANDOLPH DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-895-3100
Mailing Address - Street 1:1 SCHUMAN RD.
Mailing Address - Street 2:
Mailing Address - City:MT. FREEDOM
Mailing Address - State:NJ
Mailing Address - Zip Code:07970-0395
Mailing Address - Country:US
Mailing Address - Phone:973-895-3100
Mailing Address - Fax:973-895-3438
Practice Address - Street 1:1 SCHUMAN RD.
Practice Address - Street 2:
Practice Address - City:MT. FREEDOM
Practice Address - State:NJ
Practice Address - Zip Code:07970-0395
Practice Address - Country:US
Practice Address - Phone:973-895-3100
Practice Address - Fax:973-895-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021730001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherDENTAL PRACTICE