Provider Demographics
NPI:1922018811
Name:ROWLAND, RANDAL WADE (MS, DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:WADE
Last Name:ROWLAND
Suffix:
Gender:M
Credentials:MS, DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 UNION ST
Mailing Address - Street 2:SUITE 482
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4114
Mailing Address - Country:US
Mailing Address - Phone:415-440-8100
Mailing Address - Fax:415-440-0016
Practice Address - Street 1:2001 UNION ST
Practice Address - Street 2:SUITE 482
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4114
Practice Address - Country:US
Practice Address - Phone:415-440-8100
Practice Address - Fax:415-440-0016
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA518031223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics