Provider Demographics
NPI:1528371903
Name:RANDALL L. SANDLIN DMD PA
Entity Type:Organization
Organization Name:RANDALL L. SANDLIN DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-355-0259
Mailing Address - Street 1:1318 STRATFORD RD. S.E.
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6026
Mailing Address - Country:US
Mailing Address - Phone:256-355-0259
Mailing Address - Fax:256-355-0587
Practice Address - Street 1:1318 STRATFORD RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6003
Practice Address - Country:US
Practice Address - Phone:256-355-0259
Practice Address - Fax:256-355-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6398330001Medicare NSC