Provider Demographics
NPI:1265416242
Name:DEATON, RANDALL N (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:N
Last Name:DEATON
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:PO BOX 321
Mailing Address - Street 2:518 E MAIN ST
Mailing Address - City:ADAMSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38310-0321
Mailing Address - Country:US
Mailing Address - Phone:731-632-3371
Mailing Address - Fax:731-632-5443
Practice Address - Street 1:518 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310-0321
Practice Address - Country:US
Practice Address - Phone:731-632-3371
Practice Address - Fax:731-632-5443
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0069491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0013764Medicaid