Provider Demographics
NPI:1508068313
Name:LICHTMAN, RANDY H (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:H
Last Name:LICHTMAN
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 1:921 BOSTON TPKE.
Mailing Address - Street 2:P.O. BOX 9126
Mailing Address - City:BOLTON
Mailing Address - State:CT
Mailing Address - Zip Code:06043
Mailing Address - Country:US
Mailing Address - Phone:860-646-3003
Mailing Address - Fax:
Practice Address - Street 1:921 BOSTON TPKE.
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:CT
Practice Address - Zip Code:06043
Practice Address - Country:US
Practice Address - Phone:860-646-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT65661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice