Chantelle Elizabaeth Randall, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901601063 Issued in MI

Practice address

1978 Holland Ave
Port Huron, MI 48060-1520

Phone

(810) 987-7511

NPI assigned

Jul 25, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Jill G Brion DDS PLLC

  • General Practice Dentistry
  • Port Huron, MI
  • NPI 1790835999
  NPD (past)

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

{
    "created_epoch": "1627171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1063185296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1978 HOLLAND AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480601520",
            "telephone_number": "810-987-7511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1978 HOLLAND AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480601520",
            "telephone_number": "810-987-7511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "CHANTELLE",
        "middle_name": "ELIZABAETH",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-25",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901601063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David R Ramales
• Daniel Jeffery Rambo
• Jillian Ramsey
• Randa Jundi-Samman DMD & Alister M Mackenzie DDS PC
• Stacey Randall-Weir
• Rachelle Randall, DPM
• Adam M Randazzo, PA-C
• Jeffrey Michael Randolph, PT
• Nichole Ransberger, LPN
• Pamela Lynn Ranshaw

• General Practice Dentistry in Port Huron, MI
• Providers in Port Huron, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; 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.