Provider Demographics
NPI:1770626939
Name:RANDALL W. NUNN, D.D.S.,P.A.
Entity type:Organization
Organization Name:RANDALL W. NUNN, D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:W
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-349-9144
Mailing Address - Street 1:623 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7455
Mailing Address - Country:US
Mailing Address - Phone:732-349-9144
Mailing Address - Fax:732-286-6548
Practice Address - Street 1:623 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7455
Practice Address - Country:US
Practice Address - Phone:732-349-9144
Practice Address - Fax:732-286-6548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1017785001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty