Provider Demographics
NPI:1790495539
Name:KAREN A. RANDALL DMD LLC
Entity Type:Organization
Organization Name:KAREN A. RANDALL DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-360-3475
Mailing Address - Street 1:10761 E AVENIDA HACIENDA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-6857
Mailing Address - Country:US
Mailing Address - Phone:520-360-3475
Mailing Address - Fax:
Practice Address - Street 1:801 N WILMOT RD STE A4
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1708
Practice Address - Country:US
Practice Address - Phone:520-809-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental