Provider Demographics
NPI:1609955871
Name:KIXMILLER, RANDOLPH LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:LEWIS
Last Name:KIXMILLER
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 1:212 S TRYON ST
Mailing Address - Street 2:1502
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28281
Mailing Address - Country:US
Mailing Address - Phone:704-342-4014
Mailing Address - Fax:704-342-9806
Practice Address - Street 1:212 S TRYON ST
Practice Address - Street 2:1502
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28281
Practice Address - Country:US
Practice Address - Phone:704-342-4014
Practice Address - Fax:704-342-9806
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103687122300000X
IN6873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist