Individual provider Active NPI

Alanson Marshall Randol, D.D.S.

  • General Practice Dentistry
  • Roseburg, OR
National Provider Identifier
1477546471
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7637 Issued in OR
Practice address
1122 NW Garden Valley Blvd
Suite 103
Roseburg, OR 97470-1930
Phone
(541) 673-7437
Fax
(541) 440-1065
NPI assigned
Aug 24, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 7637 OR Primary

Addresses

Primary practice location

1122 NW Garden Valley Blvd
Suite 103
Roseburg, OR 97470-1930

Mailing address

1122 NW Garden Valley Blvd
Suite 103
Roseburg, OR 97470-1930
Phone (541) 673-7437

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20160212000455 OR Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 9931225349

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7637ORMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1477546471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 NW GARDEN VALLEY BLVD",
            "address_2": "SUITE 103",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974701930",
            "telephone_number": "541-673-7437",
            "fax_number": "541-440-1065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 NW GARDEN VALLEY BLVD",
            "address_2": "SUITE 103",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974701930",
            "telephone_number": "541-673-7437",
            "fax_number": "541-440-1065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOL",
        "first_name": "ALANSON",
        "middle_name": "MARSHALL",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "7637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.