Provider Demographics
NPI:1437222692
Name:PLATT, RANDOLPH PATTERSON (DDS)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:PATTERSON
Last Name:PLATT
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:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936
Mailing Address - Country:US
Mailing Address - Phone:928-337-2522
Mailing Address - Fax:928-337-4881
Practice Address - Street 1:100 N 13 W
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936
Practice Address - Country:US
Practice Address - Phone:928-337-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2706122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist