Active NPI
Randy H Lichtman, D.D.S.
- General Practice Dentistry
- Bolton, CT
National Provider Identifier
1508068313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6566
- Practice address
- 921 Boston Tpke.
Bolton, CT 06043 - Phone
- (860) 646-3003
- NPI assigned
- Jun 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6566 | CT | Primary |
Addresses
Primary practice location
921 Boston Tpke.
Bolton, CT 06043
Mailing address
921 Boston Tpke.
P.O. Box 9126
Bolton, CT 06043
Phone (860) 646-3003
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 |
|---|---|---|---|
| 6566 | CT | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508068313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "921 BOSTON TPKE.",
"address_2": "P.O. BOX 9126",
"city": "BOLTON",
"state": "CT",
"postal_code": "06043",
"telephone_number": "860-646-3003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "921 BOSTON TPKE.",
"city": "BOLTON",
"state": "CT",
"postal_code": "06043",
"telephone_number": "860-646-3003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICHTMAN",
"first_name": "RANDY",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CT",
"license": "6566",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolton, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.