Provider Demographics
NPI:1659415966
Name:SZUTZ, RANDALL WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:WAYNE
Last Name:SZUTZ
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 1:72775 FRANK SINATRA DR
Mailing Address - Street 2:STE B
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3229
Mailing Address - Country:US
Mailing Address - Phone:760-832-7915
Mailing Address - Fax:
Practice Address - Street 1:74930 COUNTRY CLUB DR
Practice Address - Street 2:STE# 510
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1980
Practice Address - Country:US
Practice Address - Phone:760-341-2599
Practice Address - Fax:760-836-0808
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist