Bryan Randolph DDS a Professional Dental Corporation

NPI #1164631776 in Folsom, California

Provider Information

NPI Number: 1164631776
Entity Type: Organization
Organization Name: Bryan Randolph DDS a Professional Dental Corporation
Primary Specialty: Dentist
Enumeration Date: May 21, 2007
Last Updated: Jan 6, 2014

Practice Location

Address: 1621 CREEKSIDE DR
Address 2: SUITE 101
City: Folsom
State: California
ZIP Code: 95630-3493
Phone: (916) 984-6747

Authorized Official

Name: DR. BRYAN C RANDOLPH, DDS,MS
Title: OWNER
Phone: (916) 984-6747

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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