Provider Demographics
NPI:1083710081
Name:KALP, RANDY I (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:I
Last Name:KALP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 STATE ROUTE 711
Mailing Address - Street 2:
Mailing Address - City:STAHLSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15687-1300
Mailing Address - Country:US
Mailing Address - Phone:724-593-2201
Mailing Address - Fax:
Practice Address - Street 1:1257 STATE ROUTE 711
Practice Address - Street 2:
Practice Address - City:STAHLSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15687-1300
Practice Address - Country:US
Practice Address - Phone:724-593-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020729L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS020729LOtherSTATE LICENSE NUMBER