Provider Demographics
NPI:1508965153
Name:RANDI, RUTH JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:JEAN
Last Name:RANDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 7TH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5747
Mailing Address - Country:US
Mailing Address - Phone:516-742-2961
Mailing Address - Fax:516-742-6424
Practice Address - Street 1:233 7TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5747
Practice Address - Country:US
Practice Address - Phone:516-742-2961
Practice Address - Fax:516-742-6424
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY395681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice