Provider Demographics
NPI:1629104138
Name:FURMAN, RANDALL IRIC (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:IRIC
Last Name:FURMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 LYNNHAVEN PARKWAY
Mailing Address - Street 2:STE 109
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452
Mailing Address - Country:US
Mailing Address - Phone:757-468-4684
Mailing Address - Fax:757-689-2615
Practice Address - Street 1:879 LYNNHAVEN PKWY
Practice Address - Street 2:STE 109
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-468-4684
Practice Address - Fax:757-689-2615
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
VA0401005228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist