Bradley Clayton Randall, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901019821 Issued in MI

Practice address

104 Municipal LN
Paw Paw, MI 49079-1425

Phone

(269) 657-4001

NPI assigned

Jun 5, 2008

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

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Paw Paw Family Dentistry, PLC.

  • Dentist
  • Paw Paw, MI
  • NPI 1396148342
  NPD (past) Authorized official

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212624000000",
    "number": "1750540779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490790232",
            "telephone_number": "269-657-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MUNICIPAL LN",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490791425",
            "telephone_number": "269-657-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "BRADLEY",
        "middle_name": "CLAYTON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-05",
        "last_updated": "2008-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Myah Grace Plugis
• Amanda Povlock, CTRS
• Prevos Family Markets LLC
• Amanda Rose Pung, PA-C
• Heather Ramudo, RN, BSN
• Katelin Sue Rayborn
• Reece Noel Redder
• Hannah Marie Richmond
• Karen Riffer-Reinert, LMSW
• Victoria Elizabeth Risinger

• Dentist in Paw Paw, MI
• Providers in Paw Paw, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.