Provider Demographics
NPI:1205938776
Name:THOMASON, RANDOLPH KENT (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:KENT
Last Name:THOMASON
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 1:1210 N ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-1118
Mailing Address - Country:US
Mailing Address - Phone:316-777-1151
Mailing Address - Fax:316-777-1168
Practice Address - Street 1:1210 N ROCK RD
Practice Address - Street 2:
Practice Address - City:MULVANE
Practice Address - State:KS
Practice Address - Zip Code:67110-1118
Practice Address - Country:US
Practice Address - Phone:316-777-1151
Practice Address - Fax:316-777-1168
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4725122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist