Provider Demographics
NPI:1952448557
Name:RANDALL S RUMINSON, DDS
Entity Type:Organization
Organization Name:RANDALL S RUMINSON, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RUMINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-436-4123
Mailing Address - Street 1:1011 DEVONSHIRE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5136
Mailing Address - Country:US
Mailing Address - Phone:760-436-4123
Mailing Address - Fax:
Practice Address - Street 1:1011 DEVONSHIRE DR
Practice Address - Street 2:SUITE A
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5136
Practice Address - Country:US
Practice Address - Phone:760-436-4123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty