Active NPI
Randall Craig Medefesser, DDS
- General Practice Dentistry
- Millbrae, CA
National Provider Identifier
1932338381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 54502
- Practice address
- 1149 Oakwood Drive
Millbrae, CA 94030 - Phone
- (650) 367-4300
- Fax
- (650) 367-4304
- NPI assigned
- Jul 7, 2009
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 54502 | CA | Primary |
Addresses
Primary practice location
1149 Oakwood Drive
Millbrae, CA 94030
Mailing address
1149 Oakwood Drive
Millbrae, CA 94030
Phone (650) 367-4300
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246924800000",
"number": "1932338381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1149 OAKWOOD DRIVE",
"city": "MILLBRAE",
"state": "CA",
"postal_code": "94030",
"telephone_number": "650-367-4300",
"fax_number": "650-367-4304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1149 OAKWOOD DRIVE",
"city": "MILLBRAE",
"state": "CA",
"postal_code": "94030",
"telephone_number": "650-367-4300",
"fax_number": "650-367-4304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDEFESSER",
"first_name": "RANDALL",
"middle_name": "CRAIG",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-07-07",
"last_updated": "2009-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "54502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Millbrae, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.