Provider Demographics
NPI:1780446880
Name:YVONNE RANDALL, PLLC
Entity type:Organization
Organization Name:YVONNE RANDALL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-922-9619
Mailing Address - Street 1:5401 FM 1626 STE 820
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 W WINDCREST ST STE 330
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4478
Practice Address - Country:US
Practice Address - Phone:830-990-9660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty