Provider Demographics
NPI:1689944225
Name:RANDAL P. GARVEY, DDS, LLC
Entity Type:Organization
Organization Name:RANDAL P. GARVEY, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:GARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-834-2252
Mailing Address - Street 1:815 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:UHRICHSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44683-1457
Mailing Address - Country:US
Mailing Address - Phone:740-922-3061
Mailing Address - Fax:
Practice Address - Street 1:815 N WATER ST
Practice Address - Street 2:
Practice Address - City:UHRICHSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44683-1457
Practice Address - Country:US
Practice Address - Phone:740-922-3061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.014812122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1780735910OtherINDIVIDUAL NPI