Provider Demographics
NPI:1235183310
Name:SAMUELS, RANDLE NEAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDLE
Middle Name:NEAL
Last Name:SAMUELS
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 1:22750 WOODWARD AVE
Mailing Address - Street 2:SUITE #205
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1777
Mailing Address - Country:US
Mailing Address - Phone:248-542-4050
Mailing Address - Fax:248-542-9732
Practice Address - Street 1:22750 WOODWARD AVE
Practice Address - Street 2:SUITE #205
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1777
Practice Address - Country:US
Practice Address - Phone:248-542-4050
Practice Address - Fax:248-542-9732
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010182121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice