| Randolph Smiles Llc | |
|
56 South Main Street Randolph MA 02368 | |
| (508) 676-8268 | |
| Not Available |
| Full Name | Randolph Smiles Llc |
|---|---|
| Speciality | Dentist |
| Location | 56 South Main Street, Randolph, Massachusetts |
| Authorized Official Name and Position | Ramesh Izedian (DENTIST) |
| Authorized Official Contact | 5086768268 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Randolph Smiles Llc 673 Robeson Street Fall River MA 02720 Ph: (508) 676-8268 | Randolph Smiles Llc 56 South Main Street Randolph MA 02368 Ph: (508) 676-8268 |
| NPI Number | 1043752074 |
|---|---|
| Provider Enumeration Date | 11/08/2016 |
| Last Update Date | 11/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043752074 | NPI | - | NPPES |
| 280712 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 18174 (Massachusetts) | Primary |
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