Provider Demographics
NPI:1578563029
Name:GEOGHAN, RANDOLPH E (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:E
Last Name:GEOGHAN
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 1:5590 BUTLER CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8157
Mailing Address - Country:US
Mailing Address - Phone:719-532-9983
Mailing Address - Fax:
Practice Address - Street 1:5725 ERINDALE DR
Practice Address - Street 2:SUITE110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1984
Practice Address - Country:US
Practice Address - Phone:719-528-1711
Practice Address - Fax:719-528-2558
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1047581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice