Provider Demographics
NPI:1336350362
Name:RANDOLPH, LEIGH A (DDS, MS,ABE)
Entity Type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:A
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:DDS, MS,ABE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 KENNY RD
Mailing Address - Street 2:SUITE, 120
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2430
Mailing Address - Country:US
Mailing Address - Phone:614-457-9373
Mailing Address - Fax:614-457-3496
Practice Address - Street 1:2941 KENNY RD
Practice Address - Street 2:SUITE, 120
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2430
Practice Address - Country:US
Practice Address - Phone:614-457-9373
Practice Address - Fax:614-457-3496
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH190841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics