Provider Demographics
NPI:1992851687
Name:FUHR-CARMICHAEL, RANDI JILL (DDS)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:JILL
Last Name:FUHR-CARMICHAEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1512
Mailing Address - Country:US
Mailing Address - Phone:516-889-5050
Mailing Address - Fax:
Practice Address - Street 1:230 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1512
Practice Address - Country:US
Practice Address - Phone:516-889-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04559111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice