Provider Demographics
NPI:1558657577
Name:RANDALL, COLLEEN CAULFIELD (DMD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:CAULFIELD
Last Name:RANDALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:CATHERINE
Other - Last Name:CAULFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1122 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1654
Mailing Address - Country:US
Mailing Address - Phone:203-272-7271
Mailing Address - Fax:203-272-8882
Practice Address - Street 1:1122 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1654
Practice Address - Country:US
Practice Address - Phone:203-272-7271
Practice Address - Fax:203-272-8882
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT10737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program