Provider Demographics
NPI:1518188069
Name:DALE, RANDALL MUNRO (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:MUNRO
Last Name:DALE
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 1:2210 S MILL AVE
Mailing Address - Street 2:#2
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2153
Mailing Address - Country:US
Mailing Address - Phone:480-921-2434
Mailing Address - Fax:
Practice Address - Street 1:2210 S MILL AVE
Practice Address - Street 2:#2
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-921-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice