NPIMap

Organization Active NPI

Randolph Dental Group LLC

  • General Practice Dentistry
  • Randolph, MA
National Provider Identifier
1801440656
Registry record updated Jul 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
RANDOLPH DENTAL GROUP LLC
Practice address
96 N Main St
Randolph, MA 02368-4606
Phone
(781) 963-3800
Fax
(781) 963-6906
NPI assigned
Jul 30, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2019

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

Authorized official

Name
Vicki J Kenney
Title
Credentialing Specialist
Phone
(781) 562-0457

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

96 N Main St
Randolph, MA 02368-4606

Mailing address

500 Chapman St Unit 201
Canton, MA 02021-2040
Phone (781) 562-0457

National Provider Directory

National Provider Directory
Tax ID family
Randolph Dental Group LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

96 N Main St
Randolph, MA 02368
Phone (781) 805-3001

NPI Registry JSON

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

{
    "created_epoch": "1564444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564444800000",
    "number": "1801440656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 CHAPMAN ST UNIT 201",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020212040",
            "telephone_number": "781-562-0457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 N MAIN ST",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023684606",
            "telephone_number": "781-963-3800",
            "fax_number": "781-963-6906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-30",
        "last_updated": "2019-07-30",
        "status": "A",
        "authorized_official_last_name": "KENNEY",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "781-562-0457"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Randolph, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2019; 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.