Provider Demographics
NPI:1346229614
Name:MUCCIOLI, RANDY EARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:EARL
Last Name:MUCCIOLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6300 HOSPITAL PARKWAY, SUITE 275
Mailing Address - Street 2:MUCCIOLI DENTAL
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:678-389-9955
Mailing Address - Fax:
Practice Address - Street 1:6300 HOSPITAL PKWY
Practice Address - Street 2:SUITE 275
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1828
Practice Address - Country:US
Practice Address - Phone:678-389-9955
Practice Address - Fax:678-389-9952
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0143791223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics