Paw Paw Family Dentistry, PLC.

Primary specialty

DentistTaxonomy code 122300000X

License

2901019821 Issued in MI

Legal business name

PAW PAW FAMILY DENTISTRY, PLC.

Practice address

32800 E Red Arrow Hwy
Paw Paw, MI 49079-9401

Phone

(269) 251-2286

NPI assigned

Oct 6, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Bradley Clayton Randall, DDSNPI 1750540779

Title

Owner/Dentist

Phone

(269) 657-4001

Specialties & licenses 1

Addresses

Other names 1

• Galesburg Family Dentistry Doing business as

Practitioners 1

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

• Bradley Clayton Randall, DDS

  • Dentist
  • Paw Paw, MI
  • NPI 1750540779
  NPD (past) Authorized official

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

{
    "created_epoch": "1412553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412553600000",
    "number": "1396148342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32800 E RED ARROW HWY",
            "address_2": "PO BOX 232",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490799401",
            "telephone_number": "269-251-2286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32800 E RED ARROW HWY",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490799401",
            "telephone_number": "269-251-2286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAW PAW FAMILY DENTISTRY, PLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-06",
        "last_updated": "2014-10-06",
        "status": "A",
        "authorized_official_last_name": "RANDALL",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "CLAYTON",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "269-657-4001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Galesburg Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Palma
• Joel Scott Parish, BCBA
• Grace Elizabeth Parker
• Bryan Shawn Parks, C.R.N.A.
• Paw Paw Chiropractic Clinic
• Paw Paw Village Drug, Inc.
• Paw Paw Village Drug, Inc.
• David B Peirce, MD
• Heidi Lyn Pensinger, MS, AT, ATC
• Ronald L Perry, R.PH

• Dentist in Paw Paw, MI
• Providers in Paw Paw, MI by specialty
• Dentist in Michigan

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