Carla Marta Randolph, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901019520 Issued in MI

Practice address

7555 Us12
Onsted, MI 49265-9822

Phone

(517) 467-4423

NPI assigned

Jun 6, 2007

Last updated

Oct 24, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193184000000",
    "number": "1255534558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3439 DOUGLAS RD",
            "city": "WILLIAMSTON",
            "state": "MI",
            "postal_code": "488959504",
            "telephone_number": "517-614-4599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7555 US12",
            "city": "ONSTED",
            "state": "MI",
            "postal_code": "492659822",
            "telephone_number": "517-467-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "CARLA",
        "middle_name": "MARTA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-06",
        "last_updated": "2007-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901019520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian O. Mason, LCSW, LMSW
• Brian Patrick Miklos, L.M.S.W.
• Keylea Mocnik-Darcy, MS, LPC
• Judith Ann Parros, M.A., LPC
• James Alexander Phillip, D.C.
• Mary Kathleen Stark, ATC
• Catherine Lee Tervol, RN
• Erik J Tjolsen
• United Resolution Services
• Melissa S Vansickle, MD

• General Practice Dentistry in Onsted, MI
• Providers in Onsted, 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 Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.