NPIMap

Organization Active NPI

Randolph Smiles LLC

  • Dentist
  • Randolph, MA
National Provider Identifier
1043752074
Registry record updated Nov 8, 2016
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Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
18174 Issued in MA
Legal business name
RANDOLPH SMILES LLC
Doing business as
Dental Associates Randolph
Practice address
56 South Main Street
Randolph, MA 02368
Phone
(508) 676-8268
NPI assigned
Nov 8, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2016

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

Authorized official

Name
Ramesh Izedian, DMD
Title
Dentist
Phone
(508) 676-8268

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 18174 MA Primary

Addresses

Primary practice location

56 South Main Street
Randolph, MA 02368

Mailing address

673 Robeson Street
Fall River, MA 02720
Phone (508) 676-8268

Other identifiers 1

IdentifierTypeStateIssuer
280712MedicaidMA

Other names 1

  • Dental Associates Randolph Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1478563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478563200000",
    "number": "1043752074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "673 ROBESON STREET",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "02720",
            "telephone_number": "508-676-8268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 SOUTH MAIN STREET",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "02368",
            "telephone_number": "508-676-8268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH SMILES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-08",
        "last_updated": "2016-11-08",
        "status": "A",
        "authorized_official_last_name": "IZEDIAN",
        "authorized_official_first_name": "RAMESH",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "508-676-8268",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "18174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "280712",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Associates Randolph",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Randolph, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; 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.