Provider Demographics
NPI:1871677708
Name:RANDALL L WEISEL, DDS, PA
Entity Type:Organization
Organization Name:RANDALL L WEISEL, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-536-5787
Mailing Address - Street 1:3700 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-1935
Mailing Address - Country:US
Mailing Address - Phone:727-536-5787
Mailing Address - Fax:727-530-9630
Practice Address - Street 1:3700 E BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-1935
Practice Address - Country:US
Practice Address - Phone:727-536-5787
Practice Address - Fax:727-530-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0010195261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15140OtherFORTIS
FL60453OtherBLUE CROSS BLUE SHIELD
FL9676OtherSAFEGUARD
FL4010OtherCOMPBENEFITS
FL604999OtherUNITED CONCORDIA
FL215754OtherCIGNA