Provider Demographics
NPI:1538535927
Name:RANDALL L. FOTO D.D.S.
Entity type:Organization
Organization Name:RANDALL L. FOTO D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-626-4447
Mailing Address - Street 1:645 LOTUS DR N
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3304
Mailing Address - Country:US
Mailing Address - Phone:985-626-4447
Mailing Address - Fax:985-674-6688
Practice Address - Street 1:645 LOTUS DRIVE N
Practice Address - Street 2:SUITE B
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471
Practice Address - Country:US
Practice Address - Phone:985-626-4447
Practice Address - Fax:985-674-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4782332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1538261128OtherDENTAL NPI
LA1114315876OtherNPI TYPE 2 FOR MEDICARE