Provider Demographics
NPI:1790064665
Name:KORN, RANDI J (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDI
Middle Name:J
Last Name:KORN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3309
Mailing Address - Country:US
Mailing Address - Phone:954-791-7530
Mailing Address - Fax:954-791-7146
Practice Address - Street 1:817 S UNIVERSITY DR
Practice Address - Street 2:SUITE 100A
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3309
Practice Address - Country:US
Practice Address - Phone:954-791-7530
Practice Address - Fax:954-791-7146
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN183521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics