Active NPI
Domenik Randon, DMD
- Dentist
- Whiteville, NC
National Provider Identifier
1669941852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11237
- Practice address
- 5 Whiteville Town Ctr
Whiteville, NC 28472-4401 - Phone
- (910) 212-6613
- Fax
- (910) 267-8986
- NPI assigned
- Nov 16, 2018
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 11237 | NC | Primary |
Addresses
Primary practice location
5 Whiteville Town Ctr
Whiteville, NC 28472-4401
Mailing address
3570 Masters Dr
Hope Mills, NC 28348-2278
Phone (910) 578-9844
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 |
|---|---|---|---|
| 11237 | NC | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542326400000",
"number": "1669941852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3570 MASTERS DR",
"city": "HOPE MILLS",
"state": "NC",
"postal_code": "283482278",
"telephone_number": "910-578-9844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 WHITEVILLE TOWN CTR",
"city": "WHITEVILLE",
"state": "NC",
"postal_code": "284724401",
"telephone_number": "910-212-6613",
"fax_number": "910-267-8986"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDON",
"first_name": "DOMENIK",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-11-16",
"last_updated": "2018-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "11237",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Whiteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.