Active NPI
Randall B Mayberry, DDS
- Dentist
- Klamath Falls, OR
National Provider Identifier
1336134055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D8549
- Practice address
- 2074 S 6TH St
Klamath Falls, OR 97601-3372 - Phone
- (541) 851-8110
- Fax
- (541) 851-8114
- NPI assigned
- Sep 19, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D8549 | OR | Primary |
Addresses
Primary practice location
2074 S 6TH St
Klamath Falls, OR 97601-3372
Mailing address
893 Rosemont CT
Klamath Falls, OR 97603-7154
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8549 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1336134055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "893 ROSEMONT CT",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976037154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2074 S 6TH ST",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976013372",
"telephone_number": "541-851-8110",
"fax_number": "541-851-8114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYBERRY",
"first_name": "RANDALL",
"middle_name": "B",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-19",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D8549",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Klamath Falls, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.