Randolph Richard Pitzer, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1628 Issued in ND

Practice address

2224 1St Ave W
Williston, ND 58801-6286

Phone

(701) 774-0259

Fax

(701) 774-0250

NPI assigned

Sep 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1518059484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2224 1ST AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588016286",
            "telephone_number": "701-774-0259",
            "fax_number": "701-774-0250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2224 1ST AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588016286",
            "telephone_number": "701-774-0259",
            "fax_number": "701-774-0250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PITZER",
        "first_name": "RANDOLPH",
        "middle_name": "RICHARD",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ND",
            "license": "1628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40031",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111332",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa M Peterson, PA-C
• Lynn Peterson, RPH
• Oriana Peterson
• Tamara Philpot, RD
• Ashley Pierce
• Jessi Ann Polk
• Sheila Ponzio, MD
• Priscilla Porthen
• Connie Lynn Powell
• Prairie River Therapy and Assessments

• General Practice Dentistry in Williston, ND
• Providers in Williston, ND by specialty
• General Practice Dentistry in North Dakota

• 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.

Verify at the official NPI Registry.