Provider Demographics
NPI:1083270409
Name:RANDOL MILL FAMILY DENTISTRY CENTER PLLC
Entity Type:Organization
Organization Name:RANDOL MILL FAMILY DENTISTRY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP INSURANCE PLAN MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-955-3150
Mailing Address - Street 1:1115 W RANDOL MILL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2515
Mailing Address - Country:US
Mailing Address - Phone:817-801-9311
Mailing Address - Fax:
Practice Address - Street 1:1115 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2515
Practice Address - Country:US
Practice Address - Phone:817-801-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty