Provider Demographics
NPI:1609041078
Name:ERNST, RANDOLPH (DDS)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:
Last Name:ERNST
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 1:700 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3103
Mailing Address - Country:US
Mailing Address - Phone:603-669-3131
Mailing Address - Fax:
Practice Address - Street 1:700 PINE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3103
Practice Address - Country:US
Practice Address - Phone:603-669-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice