Provider Demographics
NPI:1316015126
Name:EVERETT, RANDY POWELL (DDS)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:POWELL
Last Name:EVERETT
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 1:604 J A DOOLEY WOMACK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701
Mailing Address - Country:US
Mailing Address - Phone:870-836-7314
Mailing Address - Fax:870-836-0084
Practice Address - Street 1:604 J A DOOLEY WOMACK DRIVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701
Practice Address - Country:US
Practice Address - Phone:870-836-7314
Practice Address - Fax:870-836-0084
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2250122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist