Provider Demographics
NPI:1508988205
Name:BLINCOE, RANDALL TODD (DMD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:TODD
Last Name:BLINCOE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ORPHANAGE RD
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3072
Mailing Address - Country:US
Mailing Address - Phone:859-331-1960
Mailing Address - Fax:859-331-2257
Practice Address - Street 1:12 ORPHANAGE RD
Practice Address - Street 2:
Practice Address - City:FORT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-3072
Practice Address - Country:US
Practice Address - Phone:859-331-1960
Practice Address - Fax:859-331-2257
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist