Provider Demographics
NPI:1023179165
Name:RUMINSON, RANDALL S (DDS)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:S
Last Name:RUMINSON
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 1:4730 E INDIAN SCHOOL ROAD
Mailing Address - Street 2:PMB 120 243
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1918 E MCKELLIPS
Practice Address - Street 2:THUNDERBIRD DENTAL GROUP
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2866
Practice Address - Country:US
Practice Address - Phone:480-835-7357
Practice Address - Fax:480-649-6088
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist