William Howard Randolph, DDS
Individual provider Active NPI Dentist · Chatham, VA
NPI 1114018744 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1114018744
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 0401-005781 (VA)
- Practice address
- 6 South Main St
Chatham, VA 24531 - Phone
- (434) 432-0610
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401-005781 | VA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paul W Miller DDS PLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401-005781 | VA | Yes |
Addresses
Primary practice location
6 South Main St
Chatham, VA 24531
Mailing address
796 Double Bridge Rd
Chatham, VA 24531-4058
Phone (434) 432-1075
Other providers in Chatham, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.