Provider Demographics
NPI:1225157605
Name:VENK, RANDALL ERNEST (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:ERNEST
Last Name:VENK
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 1:709 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6918
Mailing Address - Country:US
Mailing Address - Phone:405-321-6506
Mailing Address - Fax:405-360-4570
Practice Address - Street 1:709 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6918
Practice Address - Country:US
Practice Address - Phone:405-321-6506
Practice Address - Fax:405-360-4570
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist