Provider Demographics
NPI:1477697126
Name:RANDOLPH, ROBERT ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:RANDOLPH
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 1:432 N CEDROS AVE
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1255
Mailing Address - Country:US
Mailing Address - Phone:858-755-8001
Mailing Address - Fax:858-755-9718
Practice Address - Street 1:432 N CEDROS AVE
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1255
Practice Address - Country:US
Practice Address - Phone:858-755-8001
Practice Address - Fax:858-755-9718
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice