Provider Demographics
NPI:1679099246
Name:RANDY L BALL PLLC
Entity Type:Organization
Organization Name:RANDY L BALL PLLC
Other - Org Name:SAMMAMISH ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:425-281-7898
Mailing Address - Street 1:832 LANCASTER WAY SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7176
Mailing Address - Country:US
Mailing Address - Phone:425-281-7898
Mailing Address - Fax:
Practice Address - Street 1:336 228TH AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7290
Practice Address - Country:US
Practice Address - Phone:425-657-0538
Practice Address - Fax:425-657-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE605397411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty