Provider Demographics
NPI:1689129215
Name:RANDALL I. FURMAN, DDS, PLC
Entity Type:Organization
Organization Name:RANDALL I. FURMAN, DDS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:I
Authorized Official - Last Name:FURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-468-4684
Mailing Address - Street 1:879 LYNNHAVEN PKWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7270
Mailing Address - Country:US
Mailing Address - Phone:757-468-4684
Mailing Address - Fax:757-689-2615
Practice Address - Street 1:879 LYNNHAVEN PKWY
Practice Address - Street 2:SUITE 109
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7270
Practice Address - Country:US
Practice Address - Phone:757-468-4684
Practice Address - Fax:757-689-2615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010052281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA542394Medicaid