Provider Demographics
NPI:1922134378
Name:LUM, RANDALL CAREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:CAREY
Last Name:LUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510
Mailing Address - Country:US
Mailing Address - Phone:707-745-2526
Mailing Address - Fax:707-745-2590
Practice Address - Street 1:815 FIRST STREET
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510
Practice Address - Country:US
Practice Address - Phone:707-745-2526
Practice Address - Fax:707-745-2590
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice