Provider Demographics
NPI:1609072750
Name:CARLTON, RANDALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:CARLTON
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:PO BOX 2435
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:TX
Mailing Address - Zip Code:76430-8020
Mailing Address - Country:US
Mailing Address - Phone:325-893-4010
Mailing Address - Fax:
Practice Address - Street 1:1712 N ACCESS RD
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:TX
Practice Address - Zip Code:79510-3352
Practice Address - Country:US
Practice Address - Phone:325-893-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23368122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196489211Medicaid
TX196489202Medicaid