Provider Demographics
NPI:1942334313
Name:PREWITT, RANDALL EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:EUGENE
Last Name:PREWITT
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 1:1615 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2801
Mailing Address - Country:US
Mailing Address - Phone:559-875-3927
Mailing Address - Fax:559-875-0300
Practice Address - Street 1:1615 7TH ST
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2801
Practice Address - Country:US
Practice Address - Phone:559-875-3927
Practice Address - Fax:559-875-0300
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA525661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice