Provider Demographics
NPI:1073530663
Name:NAMETH, RANDALL WALTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:WALTER
Last Name:NAMETH
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 1:716 WORTHINGTON WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-5713
Mailing Address - Country:US
Mailing Address - Phone:614-846-2222
Mailing Address - Fax:614-846-3020
Practice Address - Street 1:716 WORTHINGTON WOODS BLVD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-5713
Practice Address - Country:US
Practice Address - Phone:614-846-2222
Practice Address - Fax:614-846-3020
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.017679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist