Provider Demographics
NPI:1396484036
Name:RANDALL, PATRICK J (DMD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:RANDALL
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 1:45 HIGH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2663
Mailing Address - Country:US
Mailing Address - Phone:207-229-3698
Mailing Address - Fax:
Practice Address - Street 1:74 GRAY RD STE 3
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2062
Practice Address - Country:US
Practice Address - Phone:207-878-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4971122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist