Provider Demographics
NPI:1801912449
Name:DAVEY, RANDY L (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:L
Last Name:DAVEY
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 1:6246 FAIR OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4808
Mailing Address - Country:US
Mailing Address - Phone:916-972-8851
Mailing Address - Fax:916-972-8912
Practice Address - Street 1:6246 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4808
Practice Address - Country:US
Practice Address - Phone:916-972-8851
Practice Address - Fax:916-972-8912
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA403471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice