Provider Demographics
NPI:1891042461
Name:RANDALL, ELIZABETH FELTS (DMD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FELTS
Last Name:RANDALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:FELTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:951 RIVERFRONT PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2185
Mailing Address - Country:US
Mailing Address - Phone:423-756-2450
Mailing Address - Fax:423-756-5451
Practice Address - Street 1:951 RIVERFRONT PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2185
Practice Address - Country:US
Practice Address - Phone:423-756-2450
Practice Address - Fax:423-756-5451
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5960C11223P0300X
TN94621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics