Provider Demographics
NPI:1821591876
Name:RANDY LENDERMAN DDS PLC
Entity Type:Organization
Organization Name:RANDY LENDERMAN DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:LENDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-327-3800
Mailing Address - Street 1:2425 PRINCE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3701
Mailing Address - Country:US
Mailing Address - Phone:501-327-3800
Mailing Address - Fax:501-327-5657
Practice Address - Street 1:2425 PRINCE ST STE 1
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3701
Practice Address - Country:US
Practice Address - Phone:501-327-3800
Practice Address - Fax:501-327-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty