Provider Demographics
NPI:1023031606
Name:RANDALL, ANDREW WARREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WARREN
Last Name:RANDALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3729 AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-7202
Mailing Address - Country:US
Mailing Address - Phone:214-718-8899
Mailing Address - Fax:
Practice Address - Street 1:457 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3771
Practice Address - Country:US
Practice Address - Phone:972-436-2431
Practice Address - Fax:972-436-5633
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice