Provider Demographics
NPI:1598925869
Name:JANINE RANDAZZO, D.M.D., P.C.
Entity Type:Organization
Organization Name:JANINE RANDAZZO, D.M.D., P.C.
Other - Org Name:JANINE RANDAZZO DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-897-2900
Mailing Address - Street 1:2300 ROBIOUS STATION CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2124
Mailing Address - Country:US
Mailing Address - Phone:804-897-2900
Mailing Address - Fax:
Practice Address - Street 1:2300 ROBIOUS STATION CIR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2124
Practice Address - Country:US
Practice Address - Phone:804-897-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411243261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740257039OtherNPI TYPE I