Bryan Randolph DDS a Professional Dental Corporation

Primary specialty

DentistTaxonomy code 122300000X

License

41779 Issued in CA

Legal business name

BRYAN RANDOLPH DDS A PROFESSIONAL DENTAL CORPORATION

Practice address

1621 Creekside Dr
Suite 101
Folsom, CA 95630-3493

Phone

(916) 984-6747

Fax

(916) 984-6746

NPI assigned

May 21, 2007

Last updated

Jan 6, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bryan C Randolph, DDS,MS

Title

Owner

Phone

(916) 984-6747

Specialties & licenses 1

Addresses

Tax ID family

Bryan Randolph DDS a Professional Dental Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bryan Randolph DDS a Professional Dental Corp.

  dba The Tooth Station

  • Dental Clinic/Center
  • Sacramento, CA
  • NPI 1568884229
  NPD tax ID

Locations

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388966400000",
    "number": "1164631776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1621 CREEKSIDE DR",
            "address_2": "SUITE 101",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956303493",
            "telephone_number": "916-984-6747",
            "fax_number": "916-984-6746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1621 CREEKSIDE DR",
            "address_2": "SUITE 101",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956303493",
            "telephone_number": "916-984-6747",
            "fax_number": "916-984-6746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN RANDOLPH DDS A PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2014-01-06",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-984-6747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS,MS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "41779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerrell Scott Brown, M.D.
• Kellyrae Brown
• Kimberly B Brown, HEALTH COACH
• Nahathai Broytubtim
• Michaella Bruce
• Brittney Bryant, NP
• Amy Buchanan
• Joanna Jean Buchanan, DO
• Lisa Buhman, MA, BCBA
• Diem Thuy Thi Bui, PHARM D

• Dentist in Folsom, CA
• Providers in Folsom, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2014; 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.