Provider Demographics
NPI:1104221381
Name:RANDOLPH FAMILY & COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:RANDOLPH FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-895-4333
Mailing Address - Street 1:10 W HANOVER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4221
Mailing Address - Country:US
Mailing Address - Phone:973-895-4333
Mailing Address - Fax:
Practice Address - Street 1:10 W HANOVER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-4221
Practice Address - Country:US
Practice Address - Phone:973-895-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty