Provider Demographics
NPI:1770696775
Name:MERAZ, RANDOLPH RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:RICHARD
Last Name:MERAZ
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 1:81-022 HWY 111 #C
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-347-3486
Mailing Address - Fax:760-347-2738
Practice Address - Street 1:81-022 HWY 111 #C
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-347-3486
Practice Address - Fax:760-347-2738
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist