Provider Demographics
NPI:1396347134
Name:KERDAHI, RANDA (DMD)
Entity type:Individual
Prefix:
First Name:RANDA
Middle Name:
Last Name:KERDAHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7223 EMILY LN
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-2174
Mailing Address - Country:US
Mailing Address - Phone:848-333-9798
Mailing Address - Fax:
Practice Address - Street 1:7223 EMILY LN
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-2174
Practice Address - Country:US
Practice Address - Phone:848-333-9798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028154001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice