Provider Demographics
NPI:1447412812
Name:WEST, RANDOLPH ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:ROBERT
Last Name:WEST
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 1:295 W. BYRON NELSON BLVD.
Mailing Address - Street 2:SUITE 228
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3190
Mailing Address - Country:US
Mailing Address - Phone:682-831-9994
Mailing Address - Fax:682-831-9996
Practice Address - Street 1:295 W. BYRON NELSON BLVD.
Practice Address - Street 2:SUITE 228
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-3190
Practice Address - Country:US
Practice Address - Phone:682-831-9994
Practice Address - Fax:682-831-9996
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice