Randolph Holly, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0369901 Issued in NY

Practice address

1003 Monroe Street
Endicott, NY 13760

Phone

(607) 757-0455

Fax

(607) 757-9375

NPI assigned

Nov 9, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1871663427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 MONROE ST",
            "city": "ENDICOTT",
            "state": "NY",
            "postal_code": "137605221",
            "telephone_number": "607-757-0455",
            "fax_number": "607-757-9375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 MONROE STREET",
            "city": "ENDICOTT",
            "state": "NY",
            "postal_code": "13760",
            "telephone_number": "607-757-0455",
            "fax_number": "607-757-9375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLY",
        "first_name": "RANDOLPH",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "0369901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Regina Marie Heiland, REGISTERED NURSE
• Heather Elaine Hessberger
• Syreeta Cynthia Hill
• Kendal Ashley Hilliker, DPT
• Karen Hilmy
• Jaime Horton
• Rebecca Lynn Houston, RN
• Jean P Howard, FNP
• Kimberly Faith Howard, M.S., CCC-SLP
• Melissa Ann Howard, RN, BSN

• Oral and Maxillofacial Surgery (Dentist) in Endicott, NY
• Providers in Endicott, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.