Gregory Dwight Randolph, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D12316 Issued in TX

Practice address

7300 Blanco Rd Ste 100
San Antonio, TX 78216-4937

Phone

(210) 344-9898

Fax

(210) 344-9118

NPI assigned

Nov 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bluebonnet Oral Surgery and Implants PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • San Antonio, TX
  • NPI 1033550983
  NPD (past)
• TX Southern Dental PPO PC

  dba Bluebonnet Oral Surgery & Implants

  • Dentist
  • San Antonio, TX
  • NPI 1831933605
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1023188299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 BLANCO RD STE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782164937",
            "telephone_number": "210-344-9898",
            "fax_number": "210-344-9118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 BLANCO RD STE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782164937",
            "telephone_number": "210-344-9898",
            "fax_number": "210-344-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "GREGORY",
        "middle_name": "DWIGHT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "D12316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "D12316",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cheryl Kirby Randol, D.D.S.
• Macie Randol, RN, BSN
• Amanda Christine Randolph, MD, PHD
• Briana Patricia Randolph
• Crystal A Randolph, LCSW
• Henry Randolph, LPC
• Jennifer Vela Randow, M.S., L.P.C.
• Robert Ewing Raney Jr., D.D.S.
• Jeanette Rangel de Los Reyes, OTR
• Erika Selina Rangel Juarez, DDS

• Oral and Maxillofacial Surgery (Dentist) in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.