Provider Demographics
NPI:1336275866
Name:ARNOLD, RANDALL STEVEN (DMD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:STEVEN
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:DMD
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 815
Mailing Address - Street 2:99 CRESTVIEW DRIVE
Mailing Address - City:CLEARWATER
Mailing Address - State:SC
Mailing Address - Zip Code:29822-0815
Mailing Address - Country:US
Mailing Address - Phone:803-593-5386
Mailing Address - Fax:803-593-4511
Practice Address - Street 1:99 CRESTVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:SC
Practice Address - Zip Code:29822-0815
Practice Address - Country:US
Practice Address - Phone:803-593-5386
Practice Address - Fax:803-593-4511
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist