Provider Demographics
NPI:1649271958
Name:PRICE, RANDOLPH E
Entity type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:E
Last Name:PRICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1657
Mailing Address - Country:US
Mailing Address - Phone:541-386-3818
Mailing Address - Fax:541-386-4419
Practice Address - Street 1:1825 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1657
Practice Address - Country:US
Practice Address - Phone:541-386-3818
Practice Address - Fax:541-386-4419
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD50911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice