Provider Demographics
NPI:1811918667
Name:HEDRICK, RANDALL THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:THOMAS
Last Name:HEDRICK
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 1:4957 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-2174
Mailing Address - Country:US
Mailing Address - Phone:727-521-2285
Mailing Address - Fax:727-521-6509
Practice Address - Street 1:4957 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2174
Practice Address - Country:US
Practice Address - Phone:727-521-2285
Practice Address - Fax:727-521-6509
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL97911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics