Provider Demographics
NPI:1710347562
Name:RANDOLPH R WEST DDS PLLC
Entity Type:Organization
Organization Name:RANDOLPH R WEST DDS PLLC
Other - Org Name:WEST DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDOPH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-454-3463
Mailing Address - Street 1:295 W. BYRON NELSON BLVD
Mailing Address - Street 2:STE 304
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262
Mailing Address - Country:US
Mailing Address - Phone:817-454-3463
Mailing Address - Fax:866-892-0774
Practice Address - Street 1:295 W. BYRON NELSON BLVD
Practice Address - Street 2:STE 304
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262
Practice Address - Country:US
Practice Address - Phone:817-454-3463
Practice Address - Fax:866-892-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447412812OtherNPI TYPE 1