Dr. Samuel John Randall III, DDS
Dentist, General Practice in Charlotte, NC. Individual provider (NPI-1).
NPI number1609896331
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1609896331
- Entity type
- Individual (NPI-1)
- Name
- Dr. Samuel John Randall III
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 19, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 4393 | NC | Yes |
Practice location
6842 Morrison BlvdSuite 202
Charlotte, NC 28211-3547
Phone 704-442-7175 · Fax 704-442-7231
Mailing address
6842 Morrison Blvd.Suite 202
Charlotte, NC 28211
Phone 704-442-7175 · Fax 704-442-7231
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