Provider Demographics
NPI:1558400440
Name:KUMM, RANDAL (DDS)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:
Last Name:KUMM
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 1:3701 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3611
Mailing Address - Country:US
Mailing Address - Phone:303-761-1977
Mailing Address - Fax:303-761-2728
Practice Address - Street 1:15400 E 14TH PL
Practice Address - Street 2:SUITE 301
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-5818
Practice Address - Country:US
Practice Address - Phone:303-343-7277
Practice Address - Fax:303-343-7290
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02070589Medicaid