Provider Demographics
NPI:1144355603
Name:RANDAZZO DENTAL ASSOCIATES
Entity type:Organization
Organization Name:RANDAZZO DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:RANDAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-635-2151
Mailing Address - Street 1:43 BRIDGE ST
Mailing Address - Street 2:P O BOX 250
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-3400
Mailing Address - Country:US
Mailing Address - Phone:603-635-2151
Mailing Address - Fax:603-635-9924
Practice Address - Street 1:43 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076-3400
Practice Address - Country:US
Practice Address - Phone:603-635-2151
Practice Address - Fax:603-635-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1270122300000X
NH3390122300000X
NH34201223P0300X
NH27791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty