Gregory M Randolph DDS & Associates, Ltd
NPI #1104639004 in Bloomington, Illinois
Provider Information
- NPI Number
- 1104639004
- Entity Type
- Organization
- Organization Name
- Gregory M Randolph DDS & Associates, Ltd
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Jan 27, 2025
- Last Updated
- Jul 16, 2025
Practice Location
- Address
- 119 N WILLIAMSBURG DR
- City
- Bloomington
- State
- Illinois
- ZIP Code
- 61704-3528
- Phone
- (309) 663-1326
Authorized Official
- Name
- JENNY GARCIA-ROCHA
- Title
- SR CREDENTIALING TEAM LEAD
- Phone
- (972) 869-3789
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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