Provider Demographics
NPI:1255532636
Name:LUNENFELD, RANDY (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:LUNENFELD
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 1:115 MAIN ST
Mailing Address - Street 2:1B
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2948
Mailing Address - Country:US
Mailing Address - Phone:914-771-8888
Mailing Address - Fax:914-337-3075
Practice Address - Street 1:115 MAIN ST
Practice Address - Street 2:1B
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-2948
Practice Address - Country:US
Practice Address - Phone:914-771-8888
Practice Address - Fax:914-337-3075
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050870-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02866791Medicaid