Provider Demographics
NPI:1619329588
Name:WINGATE, RANDI (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDI
Middle Name:
Last Name:WINGATE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9159 FRANKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23354
Mailing Address - Country:US
Mailing Address - Phone:757-442-4819
Mailing Address - Fax:
Practice Address - Street 1:9159 FRANKTOWN RD.
Practice Address - Street 2:
Practice Address - City:FRANKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23354
Practice Address - Country:US
Practice Address - Phone:757-442-4819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415245122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist