Individual provider Active NPI

Randal Joseph Place, D.D.S.

  • General Practice Dentistry
  • Massena, NY
National Provider Identifier
1003834359
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
044032 Issued in NY
Practice address
276 Main St
Massena, NY 13662-1901
Phone
(315) 769-0942
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 044032 NY Primary

Addresses

Primary practice location

276 Main St
Massena, NY 13662-1901

Mailing address

276 Main St
Massena, NY 13662-1901
Phone (315) 769-0942

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150318001602 NY Order and Referring Only - DentistPractitioner - Dentist 6507183274

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
044032NYMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003834359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 MAIN ST",
            "city": "MASSENA",
            "state": "NY",
            "postal_code": "136621901",
            "telephone_number": "315-769-0942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 MAIN ST",
            "city": "MASSENA",
            "state": "NY",
            "postal_code": "136621901",
            "telephone_number": "315-769-0942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLACE",
        "first_name": "RANDAL",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "044032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Massena, NY

Sources for this page

Verify at the official NPI Registry.