Provider Demographics
NPI:1144311671
Name:LERICH, RANDALL WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:WAYNE
Last Name:LERICH
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:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-0753
Mailing Address - Country:US
Mailing Address - Phone:830-393-4965
Mailing Address - Fax:830-393-8651
Practice Address - Street 1:540 10TH ST
Practice Address - Street 2:SUITE 128
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3154
Practice Address - Country:US
Practice Address - Phone:830-393-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0145361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice