Gregory Marshall Randolph, D,D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-020416 Issued in IL

Practice address

119 N Williamsburg Dr
Bloomington, IL 61704-3528

Phone

(309) 663-1326

Fax

(309) 662-3551

NPI assigned

Feb 9, 2007

Last updated

Apr 3, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Gregory M Randolph DDS & Associates, LTD

  dba Randolph & Associates Family Dentistry

  • General Practice Dentistry
  • Bloomington, IL
  • NPI 1104639004
  NPD (past)

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1801937222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 N WILLIAMSBURG DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043528",
            "telephone_number": "309-663-1326",
            "fax_number": "309-662-3551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 N WILLIAMSBURG DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043528",
            "telephone_number": "309-663-1326",
            "fax_number": "309-662-3551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "GREGORY",
        "middle_name": "MARSHALL",
        "name_prefix": "Dr.",
        "credential": "D,D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-09",
        "last_updated": "2025-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-020416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION NUMBER",
            "identifier": "370958381",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Smitha B Rai, D.D.S.
• Lawrence Alan Raines, MD
• Renuka Rajagopal, M.D
• Rally Physical Therapy LLC
• Lakshmi Ramesh, DDS
• Laura C Randolph, M.D.
• Amanda M Ratesic
• Sara Renee Rauen Dardis, DDS, MS
• Nita Raut, APN
• Nichole Christine Rave, PA-C

• General Practice Dentistry in Bloomington, IL
• Providers in Bloomington, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; 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.