NPIMap

Organization Active NPI

Bryan Randolph DDS a Professional Dental Corp.

  • Dental Clinic/Center
  • Sacramento, CA
National Provider Identifier
1568884229
Registry record updated Jan 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
41779 Issued in CA
Legal business name
BRYAN RANDOLPH DDS A PROFESSIONAL DENTAL CORP.
Doing business as
The Tooth Station
Practice address
1954 Del Paso Rd
Suite 101
Sacramento, CA 95834-7706
Phone
(916) 419-0020
Fax
(916) 419-6787
NPI assigned
Jan 15, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2014

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

Authorized official

Name
Dr. Bryan Randolph, DDSNPI 1932267994
Title
Owner/Dentist
Phone
(916) 419-0020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 41779 CA Primary

Addresses

Primary practice location

1954 Del Paso Rd
Suite 101
Sacramento, CA 95834-7706

Mailing address

1954 Del Paso Rd
Suite 101
Sacramento, CA 95834-7706
Phone (916) 419-0020

Other names 1

  • The Tooth Station Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bryan Randolph DDS a Professional Dental Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1954 Del Paso Rd
Ste 101
Sacramento, CA 95834
Phone (916) 419-0020

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1389744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389744000000",
    "number": "1568884229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1954 DEL PASO RD",
            "address_2": "SUITE 101",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958347706",
            "telephone_number": "916-419-0020",
            "fax_number": "916-419-6787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1954 DEL PASO RD",
            "address_2": "SUITE 101",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958347706",
            "telephone_number": "916-419-0020",
            "fax_number": "916-419-6787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN RANDOLPH DDS A PROFESSIONAL DENTAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-15",
        "last_updated": "2014-01-15",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "916-419-0020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "41779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Tooth Station",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.