Gregory M Randolph DDS & Associates, LTD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GREGORY M RANDOLPH DDS & ASSOCIATES, LTD

Practice address

119 N Williamsburg Dr
Bloomington, IL 61704-3528

Phone

(309) 663-1326

NPI assigned

Jan 27, 2025

Organization subpart

No

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

Authorized official

Name

Jenny Garcia-Rocha

Title

Sr Credentialing Team Lead

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Other names 1

• Randolph & Associates Family Dentistry Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jack Charles Morkin

  • Dentist
  • Bloomington, IL
  • NPI 1639857162

  General Practice

  NPD
• Brandon P.L. Gray, D.D.S.

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1104112226
  NPD (past)
• Gregory Marshall Randolph, D,D.S.

  • General Practice Dentistry
  • Bloomington, IL
  • NPI 1801937222
  NPD (past)

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

{
    "created_epoch": "1737936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752624000000",
    "number": "1104639004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 N WILLIAMSBURG DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 N WILLIAMSBURG DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043528",
            "telephone_number": "309-663-1326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY M RANDOLPH DDS & ASSOCIATES, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-27",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A",
        "authorized_official_last_name": "GARCIA-ROCHA",
        "authorized_official_first_name": "JENNY",
        "authorized_official_title_or_position": "SR CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Randolph & Associates Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Randolph & Associates Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Francis Patrick Green, DDS,MS
• Janis Eileen Green
• Sarah Greenberg
• Brandon Jeremy Greenfield, MD
• Tamar Greenly, APRN
• Cally Christine Grey
• Taylor Mae Griem
• M Allan Griffith, MD
• Mariellen Griffith, ED.D.
• Andrea Lynn Grimes

• General Practice Dentistry in Bloomington, IL
• Providers in Bloomington, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; 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.